TITLE:
The Financial Toxicity of Anemia Management among Patients on Chronic Hemodialysis: A Cross-Sectional Study on Blood Transfusion Costs and Care Disruption in Douala, Cameroon
AUTHORS:
Hermine Danielle Epse Ebana Fouda Menye, Jean Yves Balepna, Lionel Elimby, Arlette Gerardine Nguéa, Vincent Ngamby, Rodin Simo Kiegaing, Marie Patrice Halle, Eveline Ngouadjeu Dongho
KEYWORDS:
Hemodialysis, Blood Transfusion, Economic Burden, Perceived Quality of Life, Cameroon
JOURNAL NAME:
Open Journal of Nephrology,
Vol.16 No.3,
September
9,
2026
ABSTRACT: Background: Chronic hemodialysis patients frequently require blood transfusions due to persistent anemia. However, in many sub-Saharan African settings, patients face substantial informal costs when sourcing blood products. These hidden, out-of-pocket expenses remain poorly quantified, limiting policymakers’ ability to effectively address financial barriers to safe and timely transfusions. Methods: A cross-sectional survey was conducted among patients undergoing chronic hemodialysis at the two public hemodialysis facilities in Douala, Cameroon. A total of 168 patients were interviewed. Variables assessed included sociodemographic and economic characteristics, anemia management data, estimated cost per blood unit, impact on hemodialysis non-adherence, and perceived quality-of-life effects. Descriptive and bivariate analyses were performed. Results: A total of 168 (males 53%, n = 89) patients were included; the mean age was 49 ± 12 years. Low socio-economic status was prevalent (58.3%, n = 98) and 65.5% (n = 110) had a monthly income Conclusion: Transfusion costs constitute a major and under-recognized barrier to timely access to blood among chronic hemodialysis patients in our setting. The combination of high out-of-pocket expenses with intermediary and donor payments is associated with increased socioeconomic vulnerability, hemodialysis nonadherence, and impaired quality of life.