Cost of chemotherapy-related care for breast cancer care: evidence and implications from a provider perspective at a public tertiary hospital in South Africa

BACKGROUND: South Africa (SA) is an upper-middle-income country with high-income disparity and coexisting private and public healthcare systems that create considerably differing breast cancer (BC) treatment outcomes. State-funded BC care is available in the public tertiary and quaternary hospitals, including surgery, chemotherapy, endocrine therapy, and radiation therapy, although the timely access to these modalities is often expensive and unpredictable. In a resource-constrained country like South Africa, understanding the total cost of BC care is crucial for health funders when budgeting and making decisions. There has been no systematic assessment of the financial impact of BC in the South African (SA) public sector. OBJECTIVES: To estimate the cost of BC treatment with chemotherapy, including the associated costs, laboratory tests, radiological and consumables at a public tertiary hospital in SA. METHODOLOGY: The study design was descriptive and retrospective file review of patients with breast cancer to obtain patients’ data. The data collection lasted three months, from July 2022 to September 2022. The study population included files of all adult patients who had received chemotherapy between 2018 and 2022. A total of 364 patient files were examined. RESULTS: A total of 364 breast cancer patients were included, with a mean age of 55.5 ± 13.3 years. Most patients presented with advanced disease: 39% at stage 3B and 26.1% at stage 4. The overall direct cost of treatment was R4.8 million, with a mean cost per patient of R 13,365.90. The most significant cost drivers were laboratory tests (34%), administrative overheads (27%), and chemotherapy (22%). The most frequently prescribed chemotherapy regimen was CAF (cyclophosphamide, adriamycin, 5-fluorouracil), given to 70.9% of patients. Stage 1 is a major outlier, costing 55% less than the mean average, while Stage 2 A is the most expensive per-patient stage, costing 11.6% more than the mean average. CONCLUSION: This study showed that direct costs were substantial and primarily influenced by chemotherapy, administrative, and laboratory costs. This research indicates that the direct provider costs for breast cancer treatment at a South African public tertiary hospital are considerable. A significant proportion of patients are diagnosed at advanced stages, but what drove the costs was repeated, cycle-based resource utilisation rather than by chemotherapy drug costs alone.