School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa.
S Afr Med J. 2020 Mar 30;110(4):296-301. doi: 10.7196/SAMJ.2020.v110i4.14204.
There has been no comprehensive study determining the financial burden of breast cancer in the South African (SA) public sector.
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 government hospital in SA. These costs included costs associated with the management of adverse events arising from chemotherapy.
Retrospective patient-level data were collected for 200 patients from electronic databases and patient folders between 2013 and 2015. Direct medical costs were determined from the health funder's perspective. The information collected was categorised into the following cost components: chemotherapy medicines, support medicines, administration of chemotherapy, laboratory tests, radiology scans and imaging, doctor consultations and adverse events. Time-and-motion studies were conducted on a set of new patients and the data obtained were used for the study sample of 200 patients. All the above costs were used to determine the cost of chemotherapy per episode of care. 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).
A method was developed to determine the episode-of-care costs for breast cancer at GSH. The total direct medical cost for treatment of breast cancer at GSH for 200 patients was ZAR3 154 877, and the average episode-of-care cost per patient was ZAR15 774. The average cost of management of adverse events arising from the various treatment modalities was ZAR13 133 per patient. It was found that the cost of treating a patient with adverse events was 1.8 times higher than the cost of treating a patient without adverse events. Of the patients, 86.5% managed to complete their prescribed chemotherapy treatment cycles, and the average cost of treatment of these patients was 1.3 times more than the average cost for patients who could not complete their treatment, based on the number of treatment cycles received.
A comprehensive method to determine the costs associated with breast cancer management per episode of care was developed, and costs were quantified at GSH according to the treatment protocol used at the hospital.
目前尚无综合性研究确定南非公共部门乳腺癌的财务负担。
开发一种方法，以确定每例乳腺癌化疗的治疗成本，并量化与 Groote Schuur 医院（GSH）化疗相关的成本，GSH 是南非的一家政府医院。这些成本包括与化疗相关的不良反应管理相关的成本。
在 2013 年至 2015 年间，从电子数据库和患者档案中收集了 200 名患者的回顾性患者水平数据。从医疗保健支付方的角度确定了直接医疗成本。收集到的信息被分为以下成本构成部分：化疗药物、支持性药物、化疗给药、实验室检查、放射学扫描和成像、医生咨询和不良反应。对一组新患者进行了时间和动作研究，并将获得的数据用于 200 名患者的研究样本。所有上述成本均用于确定每例化疗的成本。治疗周期被定义为从开始化疗前 2 个月（化疗前阶段）、化疗期间（治疗阶段）到最后一个化疗周期给药后 6 个月（随访阶段）期间提供的护理。
开发了一种确定 GSH 乳腺癌治疗周期成本的方法。200 名患者在 GSH 治疗乳腺癌的总直接医疗费用为 315487 南非兰特，每位患者的平均治疗周期成本为 15774 南非兰特。每位患者因各种治疗方式引起的不良反应管理的平均成本为 13133 南非兰特。发现治疗有不良反应的患者的成本比治疗无不良反应的患者的成本高 1.8 倍。在患者中，86.5%的患者能够完成规定的化疗治疗周期，而根据接受的治疗周期数，这些患者的治疗成本是无法完成治疗的患者的平均成本的 1.3 倍。
开发了一种综合方法，以确定每例乳腺癌护理的相关成本，并根据医院使用的治疗方案在 GSH 量化了成本。
