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

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.