Colorectal Cancer (CRC) treatment and associated costs in the public sector compared to the private sector in Johannesburg, South Africa

Abstract

Background: 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 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. Methods: Private 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. Results: The 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. Conclusion: This comparison highlights the disparities between sectors while illustrating the need for further research to improve resource management to attain equitable healthcare.

The pathogenic roles of lncRNA-Taurine upregulated 1 (TUG1) in colorectal cancer

“…Although the role of TUG1 in the characteristics and chemoresistance of CRC stem cells is still not well-defined, it has been already presented as an attractive potential biomarker because of its tumor-promotive function via diverse mechanisms, such as RNA-RNA and RNA/transcription factors interactions [ 46 , 84 ]. It was investigated by the same group that TUG1 increased the characteristics and oxaliplatin resistance of CRC stem cells by enhancing GATA6 stability [ 14 ]. TUG1 is suggested to solve the problem of fluoropyrimidine (Fu)-based chemotherapy.…”

“…It has been found that the combination of chemotherapy and anti-EGFR (epidermal growth factor receptor) monoclonal antibodies cetuximab and panitumumab can prolong the median survival rate of these patients by 2 to 4 months compared with chemotherapy alone [ 12 ]. However, the impact of these therapies on the 5-year survival remains limited and very expensive [ 13 , 14 ]. Several mutations in oncogenes, tumor suppressor genes, and genes associated with DNA repair have been identified as genetic risk factors for CRCs [ 15 ].…”

Pharmacogenetics of Breast Cancer Treatments: A Sub-Saharan Africa Perspective

“… 112 , 113 Although capecitabine is not widely used in the African public health sector, reports show that it is being used in Nigeria and South Africa, at least. 8 , 114 , 115 …”

Cost‐effectiveness of adjuvant chemotherapy for high‐risk stage II and stage III colon cancer in South Africa

“…Resource-stratified guidelines for the treatment of colon cancer patients in low resource settings also recommend adjuvant chemotherapy, but data is sparse on adherence to these guidelines among practitioners. [8][9][10][11] Additionally, a large cohort study of breast cancer patients treated across several public hospitals in ZA showed that 25% of eligible patients do not initiate adjuvant systemic therapy, despite availability at low or no cost. 12 This data, despite being in a different tumor, suggest that adjuvant chemotherapy uptake is likely suboptimal in this setting.…”

“…Post‐surgery adjuvant chemotherapy is standard of care for patients with high‐risk stage II and those with stage III colon cancer (CC) in high‐income countries (HICs). Resource‐stratified guidelines for the treatment of colon cancer patients in low resource settings also recommend adjuvant chemotherapy, but data is sparse on adherence to these guidelines among practitioners 8–11 . Additionally, a large cohort study of breast cancer patients treated across several public hospitals in ZA showed that 25% of eligible patients do not initiate adjuvant systemic therapy, despite availability at low or no cost 12 .…”