Development of a method to determine the cost of breast cancer treatment with chemotherapy at Groote Schuur Hospital, Cape Town, South Africa

Abstract

Breast cancer is one of the major healthcare challenges in South Africa (SA). Data published by the National Cancer Registry [1] in 2014 showed that breast cancer represented 22% of all cancers affecting women in SA, making it the most prevalent cancer affecting women in this country. Understanding the total cost of care for breast cancer is important from a health funder perspective, i.e. policymakers and hospital administration, in budget allocation and in decision-making [2] in a resource-constrained environment. Objectives To develop a method to determine the cost of breast cancer treatment with chemotherapy per episode of care and to quantify the associated costs relating to chemotherapy at Groote Schuur Hospital (GSH), a tertiary government hospital in Western Cape Province, SA. These costs included costs associated with the management of adverse events arising from chemotherapy. Methods Study design A retrospective cohort analysis was performed to determine the cost of an episode of care for treatment of breast cancer with chemotherapy. Cost estimates for an episode of care were obtained for each stage of breast cancer. The episode of care was defined as the care provided from 2 months prior to the date of commencing chemotherapy (pre-chemotherapy phase), during chemotherapy (treatment phase) and until 6 months after the date when the last cycle of chemotherapy was administered (follow-up phase). The episode of care was on average a period of 10-12 months per patient. Participants A total of 1 024 patients were extracted from the electronic database. Two hundred patients were randomly selected using a random number generator. Patients were included in the study based on the following criteria: (i) a diagnosis of breast cancer; (ii) registration date at the oncology department from 1 April 2013 to 31 March 2015; (iii) evidence of receipt of chemotherapy with two or more health encounters [3] related to breast cancer, e.g. doctor consultation in oncology ward and a mammogram; and (iv) age ≥18 years. Patients were excluded from the study based on the following criteria: (i) male; (ii) initiated on hormone therapy but not chemotherapy; (iii) enrolled in a clinical trial; and (iv) a primary diagnosis of cancer that was not breast cancer. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Effects of Minimum Unit Pricing for Alcohol in South Africa Across Different Drinker Groups and Wealth Quintiles: A Modelling Study

“…A limitation of our study is the lack of high-quality pricing data for SA. Previous studies in HIC have found that moderate drinkers, even those on lower incomes, purchase relatively little cheap alcohol, 24 while the price data used in our model suggest that all drinker groups purchase some cheap alcohol. It is unclear whether this is a true reflection of alcohol purchasing patterns in SA or a limitation of the data.…”

“…Our research aligns with studies from other countries, which suggest that minimum pricing will reduce alcohol sales and also corresponds to mechanisms, such as greater impact with a rising MUP threshold and greater impact on the poor, found in the international literature. 24 25 We add to the South African minimum pricing evidence currently available 26 by incorporating health outcomes, Open access accommodating homebrew and exploring differential impacts by wealth groups. Van Walbeek and Chelwa 26 who produced an economic model to simulate the impact of a MUP on consumption (with no epidemiological modelling) suggest both a higher reduction in consumption and a greater difference in consumption impact between heavy and moderate drinkers.…”

“…This assumes just one patient day. Conservative 24. Breast CancerEarly stage R14,915 Late stage R16,869…”

Estimating the healthcare cost of overweight and obesity in South Africa

“…South African studies show that stroke patients utilize allied services like speech-therapy and physiotherapy [ 50 , 51 ] hence the cost of such allied services were accounted for. For diseases like breast (chemotherapy), prostate (chemotherapy) and cervical (chemoradiotherapy) cancers, costs were estimated in line with previous studies [ 49 , 52 ] and clinical guidelines for the management and treatment of cancers [ 53–56 ]. Using 2013–2015 administrative data, Guzha et al [ 52 ] estimated the cost of breast cancer treatment.…”

“…For diseases like breast (chemotherapy), prostate (chemotherapy) and cervical (chemoradiotherapy) cancers, costs were estimated in line with previous studies [ 49 , 52 ] and clinical guidelines for the management and treatment of cancers [ 53–56 ]. Using 2013–2015 administrative data, Guzha et al [ 52 ] estimated the cost of breast cancer treatment. This cost was estimated prior to the publication of the National Department of Health (NDOH) breast cancer treatment guideline [ 53 ], necessitating an update of this cost based on the new guidelines.…”