Colorectal cancer in South Africa: An assessment of disease presentation, treatment pathways and 5-year survival

Brand, M; Gaylard, P; Ramos, J

doi:10.7196/samj.2017.v108i2.12338

Cited by 27 publications

(25 citation statements)

References 4 publications

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“…). Following assessment, 68 articles, involving 708 032 patients across 71 LMICs, were included in the review ( Tables S1 and S2 , supporting information). Country‐specific patient numbers were reported in 60 studies but were absent from six and two provided total LMIC patient numbers only.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of data sets identified arose from prospective cohorts of patients. Several of these studies were performed in single centres or single nations, with comparisons made with high‐income countries. The largest cohort of patients originated from the DATASUS registry in Brazil (428 346 patients), which explored outcomes after hysterectomy.…”

Section: Resultsmentioning

confidence: 99%

“…a Number of studies and b number of patients in studies of LMICs. Countries with fewer than 100 patients recruited for a multinational study were excluded from a , as were studies in which LMIC‐specific patient numbers were not specified…”

Section: Resultsmentioning

confidence: 99%

“…Outcomes following cancer surgery were common topics, including breast, gastric, colorectal and prostate cancer, and hepatocellular carcinoma. Cardiac surgery, caesarean section and genitourinary fistula were also well represented in included articles, whereas clinical presentations included burn management, trauma, appendicitis, groin hernias and orthopaedic fracture management.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of the use of big data to improve surgery in low- and middle-income countries

Knight

Ots

Maimbo

et al. 2019

British Journal of Surgery

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Background Technological advances have led to the generation of large amounts of data, both in surgical research and practice. Despite this, it is unclear how much originates in low‐ and middle‐income countries (LMICs) and what barriers exist to the use of such data in improving surgical care. The aim of this review was to capture the extent and impact of programmes that use large volumes of patient data on surgical care in LMICs. Methods A PRISMA‐compliant systematic literature review of PubMed, Embase and Google Scholar was performed in August 2018. Prospective studies collecting large volumes of patient‐level data within LMIC settings were included and evaluated qualitatively. Results A total of 68 studies were included from 71 LMICs, involving 708 032 patients. The number of patients in included studies varied widely (from 335 to 428 346), with 25 reporting data on 3000 or more LMIC patients. Patient inclusion in large‐data studies in LMICs has increased dramatically since 2015. Studies predominantly involved Brazil, China, India and Thailand, with low patient numbers from Africa and Latin America. Outcomes after surgery were commonly the focus (33 studies); very few large studies looked at access to surgical care or patient expenditure. The use of large data sets specifically to improve surgical outcomes in LMICs is currently limited. Conclusion Large volumes of data are becoming more common and provide a strong foundation for continuing investigation. Future studies should address questions more specific to surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of the use of big data to improve surgery in low- and middle-income countries

Knight

Ots

Maimbo

et al. 2019

British Journal of Surgery

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“…Recent research on a similar database to the one used in this study focuses on surgical procedures and outcomes for CRC in a privately insured patient cohort. While valuable information is obtained from this research it does not address issues around cost and concerns only one of South Africa's health sectors [24]. Apart from this analysis, published literature regarding the costs in the private healthcare sector and differences between the sectors associated with receiving CRC chemotherapy is lacking.…”

Section: Introductionmentioning

confidence: 99%

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

Herbst

Miot

Moch

et al. 2020

BMC Health Serv Res

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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.

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

et al. 2023

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BackgroundColon cancer incidence is rising in low‐ and middle‐income countries (LMICs), where resource limitations and cost often dictate treatment decisions. In this study, we evaluate the cost‐effectiveness of adjuvant chemotherapy for high‐risk stage II and stage III colon cancer treatment in South Africa (ZA) and illustrate how such analyses can inform cancer treatment recommendations in a LMIC.MethodsWe created a decision‐analytic Markov model to compare lifetime costs and outcomes for patients with high‐risk stage II and stage III colon cancer treated with three adjuvant chemotherapy regimens in a public hospital in ZA: capecitabine and oxaliplatin (CAPOX) for 3 and 6 months, and capecitabine for 6 months, compared to no adjuvant treatment. The primary outcome was the incremental cost‐effectiveness ratio (ICER) in international dollars (I$) per disability‐adjusted life‐year (DALY) averted, at a willingness‐to‐pay (WTP) threshold equal to the 2021 ZA gross domestic product per capita (I$13,764/DALY averted).ResultsCAPOX for 3 months was cost‐effective for both patients with high‐risk stage II and patients with stage III colon cancer (ICER = I$250/DALY averted and I$1042/DALY averted, respectively), compared to no adjuvant chemotherapy. In subgroup analyses of patients by tumor stage and number of positive lymph nodes, for patients with high‐risk stage II colon cancer and T4 tumors, and patients with stage III colon cancer with T4 or N2 disease. CAPOX for 6 months was cost‐effective and the optimal strategy. The optimal strategy in other settings will vary by local WTP thresholds. Decision analytic tools can be used to identify cost‐effective cancer treatment strategies in resource‐constrained settings.ConclusionColon cancer incidence is increasing in low‐ and middle‐income countries, including South Africa, where resource constraints can impact treatment decisions. This cost‐effectiveness study evaluates three systemic adjuvant chemotherapy options, compared to surgery alone, for patients in South African public hospitals after surgical resection for high‐risk stage II and stage III colon cancer. Doublet adjuvant chemotherapy (capecitabine and oxaliplatin) for 3 months is the cost‐effective strategy and should be recommended in South Africa.

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Colorectal cancer in South Africa: An assessment of disease presentation, treatment pathways and 5-year survival

Cited by 27 publications

References 4 publications

Systematic review of the use of big data to improve surgery in low- and middle-income countries

Systematic review of the use of big data to improve surgery in low- and middle-income countries

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

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

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