Division of Pharmacology, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 39 Empire Road, Parktown, Johannesburg, 2193, South Africa.
BMC Health Serv Res. 2020 Apr 7;20(1):290. doi: 10.1186/s12913-020-05112-w.
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.
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.
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.
This comparison highlights the disparities between sectors while illustrating the need for further research to improve resource management to attain equitable healthcare.
南非的医疗保健系统分为两个部分，服务对象和治疗方法都不同，但每年的医疗保健支出却相似。因此，人们认为这种医疗保健系统是不公平的。各部门提供的治疗方案的适宜性，尤其是相同治疗方案的费用，仍然存在争议，这引发了人们对公平医疗保健的关注。结直肠癌给资金提供者带来了相当大的压力，但南非的非传染性疾病（特别是结直肠癌）治疗利用数据和相关成本有限。因此，需要合理管理资源，同时确保无论患者在哪里接受治疗，都能提供公平的医疗保健。本研究旨在确定私人保险患者群体中结直肠癌治疗的成本，以便将成本和利用情况与之前发表的公共部门患者队列进行比较。
使用 2012 年至 2014 年所有新诊断的 CRC 患者的匿名索赔数据确定私人部门的成本。将从该患者队列中获得的成本与同期之前发表的公共部门数据进行比较。所比较的成本是由相关部门资金提供者承担的成本，不包括自付费用。
比较结果显示，私人部门的患者能够获得更多的批准方案（12 种与 4 种），但相同的方案成本更高，例如 CAPOX 每周期费用增加约 150 欧元。5FU 和卡培他滨单药治疗的成本差异每周期小于 30 欧元，而在私人部门，伊立替康比奥沙利铂便宜（FOLFOX 约 500 欧元与 FOLFIRI 约 460 欧元）。行政成本占总成本的 45%，而之前发表的南非公共医疗保健系统的这些成本总计占总治疗费用的<15%。
该比较突出了部门之间的差异，同时说明了需要进一步研究以改善资源管理，实现公平医疗保健。
