Access to colorectal cancer (CRC) chemotherapy and the associated costs in a South African public healthcare patient cohort

Reported colorectal cancer incidence is increasing in South Africa and places strain on the public healthcare system especially as costs associated with chemotherapy globally are rising. The exact costs associated with colorectal cancer chemotherapy in South Africa however have not been previously determined. This study aimed to determine the costs of early and advanced colorectal cancer chemotherapy based on the clinical pathways used in the public healthcare sector. A retrospective chemotherapy medicine utilisation review (2012-2014) was conducted at a public healthcare Medical Oncology Clinic and the costs of chemotherapy, administration and concomitant/supportive therapies calculated based on the patient cohort (n = 162). These costs were compared to theoretical costs, based on the developed clinical pathways, standard dosages and treatment cycles. First line treatments for early and advanced colorectal cancer comprised mainly of oral capecitabine, either alone or in combination. The medicine utilisation shows the use of capecitabine to be favoured over infusional 5-FU/LV for convenience reasons. Oxaliplatin was usually combined with either fluoropyrimidine (early and advanced disease) however some patients received second line irinotecan albeit was not on the Essential Medicine List at the time. Our findings reflect the complexity of CRC chemotherapy treatment with more pharmacoeconomic and outcomes research required in order to refine the clinical pathways as well as improve access to care in resource constrained settings.