Direct Cost Analysis of Diagnostic Digestive Endoscopy Based on Indications and Results in Yaoundé: Policy Implications for Universal Health Coverage in Cameroon

In low-income countries, the cost of digestive endoscopy procedures is often unknown, yet its understanding is crucial for including them in the universal health coverage benefit package. The management of digestive endoscopy requires substantial financial contribution from patients, especially in Cameroon where more than 70% of health expenditures are incurred by households. This study assessed the direct costs of diagnostic digestive endoscopy, based on indications and patient outcomes in Yaoundé, Cameroon. A retrospective cross-sectional study was conducted, over a period of twelve months in the digestive endoscopy units of two referral health facilities (one private and one public). The sampling exhaustively included the reports of gastroscopies and diagnostic colonoscopies. Direct costs were estimated from expenditures for examination, anaesthesia, biopsy, colonic preparation in the patient's perspective in relation to clinical indications, endoscopies (type of anaesthesia, type of endoscopy, biopsy, results) of gastroscopies and colonoscopies performed. The average total cost was estimated by dividing the overall total cost by the number of patients. The costs were expressed in Central Africa Francs XAF, and US Dollars ($1= 554.24 XAF). Statistical analyses used the non-parametric Mann-Whitney test. Differences at the 5% threshold were considered significant. A total of 1,147 reports met our selection criteria: 754 gastroscopies and 393 diagnostic colonoscopies with an average patient age of 45 years. In gastroscopy, 46.8% were men and 53.2% were women, while in colonoscopy, there were 58.3% men and 41.7% women. The average direct cost of gastroscopy was estimated at 46,981 XAF ($84.77) per patient; while the cost of colonoscopy was 117,692 XAF ($212.35) per patient. The main indications that influenced the overall direct cost of gastroscopy were: pyrosis with 42,000 XAF ($75.7) and melena with 45,000 XAF ($81). The endoscopic findings responsible for a fluctuation in this cost were mainly: bulbar ulcer and absence of lesions, each with 60,000 XAF ($108.11). The overall direct cost of colonoscopy was influenced by indications such as: rectorrragies with 109,000 XAF ($196.4) and abdominal pain with 108,200 XAF ($194.96); as well as by certain results such as: absence of lesions with 108,000 XAF ($194.59) and colonic polyps with 142,000 XAF ($255.86). The study concludes that digestive endoscopy was likely expensive in the study setting. Often some inappropriate indications were posed, such as pyrosis and abdominal pain, thereby contributing to increase the cost of digestive endoscopy. This makes digestive endoscopy financially inaccessible to less well-off patients. The policy implications lies in providing evidence for subsidising the costs of digestive endoscopy as part of universal health coverage benefit package in Cameroon.