Abstract
BackgroundSouth Africa’s divided healthcare system is believed to be inequitable as the population serviced by each sector and the treatment received differs while annual healthcare expenditure is similar. The appropriateness of treatment received and in particular the cost of the same treatment between the sectors remains debatable and raises concerns around equitable healthcare. Colorectal cancer places considerable pressure on the funders, yet treatment utilization data and the associated costs of non-communicable diseases, in particular colorectal cancer, are limited for South Africa. Resources need to be appropriately managed while ensuring equitable healthcare is provided regardless of where the patient is able to receive their treatment. Therefore the aim of this study was to determine the cost of colorectal cancer treatment in a privately insured patient population in order to compare the costs and utilization to a previously published public sector patient cohort.MethodsPrivate sector costs were determined using de-identified claim-based data for all newly diagnosed CRC patients between 2012 and 2014. The costs obtained from this patient cohort were compared to previously published public sector data for the same period. The costs compared were costs incurred by the relevant sector funder and didn’t include out-of-pocket costs.ResultsThe comparison shows private sector patients gain access to more of the approved regimens (12 vs. 4) but the same regimens are more costly, for example CAPOX costs approximately €150 more per cycle. The cost difference between 5FU and capecitabine monotherapy is less than €30 per cycle however, irinotecan is cheaper in comparison to oxaliplatin in the private sector (FOLFOX approx. €500 vs. FOLFIRI aprox. €460). Administrative costs account for up to 45% of total costs compared to the previously published data of these costs totaling < 15% of the full treatment cost in South Africa’s public healthcare system.ConclusionThis comparison highlights the disparities between sectors while illustrating the need for further research to improve resource management to attain equitable healthcare.
Highlights
South Africa’s divided healthcare system is believed to be inequitable as the population serviced by each sector and the treatment received differs while annual healthcare expenditure is similar
The public healthcare system is funded by the yearly national income taxation collection and the resource allocation is overseen by the National Department of Health (NDoH) via the individual Provincial Health Departments [2]
Patient cohort demographics and treatment pathways The private sector patient cohort comprised of 729 males (56%) and 567 females (44%) with a mean age, regardless of colorectal cancer (CRC) stage, of 63 years
Summary
South Africa’s divided healthcare system is believed to be inequitable as the population serviced by each sector and the treatment received differs while annual healthcare expenditure is similar. Part of the resource allocation includes medicine selection and access through the Essential Drugs Program (EDP), comprising of the Essential Medicines List (EML) and Standard Treatment Guidelines (STGs) These are used as a guideline for the PMBs as set out by the Medical Schemes Act [3, 4]. Overall total expenditures, incurred for the two funders remain similar between sectors despite the difference in the size of the population benefiting [1, 2] This substantiates the belief that the South African healthcare system is inequitable especially for diseases where less attention is paid such as cancer
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