Costing the national clinical guidelines for prostate cancer control and management in South Africa: Public sector perspective
DOI:
https://doi.org/10.7196/SAMJ.2026.v116i1.2678Keywords:
Prostate Cancer, Cost of illness, Clinical guidelinesAbstract
Background. Prostate cancer (PCa) is the second most common cancer worldwide and the sixth leading cause of cancer deaths in men. In South Africa (SA), PCa accounts for ~13% of male deaths. The direct medical costs associated with PCa diagnosis and treatment according to the national clinical guidelines for prostate cancer control and management are not documented.
Objectives. To estimate the direct medical costs for localised PCa diagnosis and treatment according to the national clinical guidelines for prostate cancer control and management in SA.
Methods. The direct medical costs for diagnosis and treatment of prostate cancer were estimated from the payer’s perspective using a micro- costing approach, with a time horizon of 12 months. Cost items were identified from the national PCa clinical guidelines and quantified according to the treatment options for low- (LRPCa), intermediate- (IRPCa) and high-risk (HRPCa) categories. Cost data were obtained from different government databases. The unit costs and PCa incidence data from 2022 were then used to estimate total costs for treating all new PCa cases. Total costs were calculated for each treatment method listed in the clinical guidelines according to PCa risk categories.
Results. The total cost for treating 10 944 new PCa cases in 2022 was estimated at ZAR2.1 billion. Per patient costs ranged from ZAR7 265 to ZAR143 156 for LRPCa, ZAR8 926 to ZAR144 817 for IRPCa and ZAR14 874 to ZAR151 872 for HRPCa. The total cost for managing all patients with LRPCa, IRPCa and HRPCa were estimated at ZAR401.3 million, ZAR371.1 million and ZAR1.4 billion, respectively.
Conclusion. This study estimated the cost for diagnosis and treatment of localised PCa according to national clinical guidelines for PCa control and management. The costs increased with each risk category of the cancer. The study highlights the need for policy-makers to increase early detection and management, to reduce the need for high-cost interventions.
References
1. Adeloye D, David RA, Aderemi AV, et al. An estimate of the incidence of prostate cancer in Africa: A systematic review and meta-analysis. PLoS ONE 2016;11(4):e0153496. https://doi.org/10.1371/journal. pone.0153496
2. JamesND,TannockI,N’DowJ,etal.TheLancetCommissiononprostatecancer:Planningforthesurge in cases. Lancet 2024;403(10437):1683-1722. https://doi.org/10.1016/S0140-6736(24)00651-2.
3. WangL,LuB,HeM,WangY,WangZ,DuL.Prostatecancerincidenceandmortality:Globalstatusand temporal trends in 89 countries from 2000 to 2019. Front Public Health 2022;10:811044. https://doi. org/10.3389/fpubh.2022.811044
4. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024;74(3):229-263. https:// doi.org/10.3322/caac.21834
5. LeRouxHA,UrryRJ,SartoriusB,AldousC.ProstatecancerataregionalhospitalinSouthAfrica:Weare only seeing the tip of the iceberg. S Afr J Surg 2015;53(3 and 4):57-62.
6. Seraphin TP, Joko-Fru WY, Kamaté B, et al. Rising prostate cancer incidence in sub-Saharan Africa: A trend analysis of data from the African Cancer Registry Network. Cancer Epidemiol Biomarkers Prevent 2021;30(1):158-165. https://doi.org/10.1158/1055-9965.EPI-20-1005.
7. StatisticsSouthAfrica.CancerinSouthAfrica(2008-2019).Pretoria:StatsSA,2023.
8. Finestone E, Wishnia J. Estimating the burden of cancer in South Africa. S Afr J Oncol 2022;6(0):a220.
https://doi.org/10.4102/sajo.v6i0.220
9. GrahamNJ,SouterLH,SalamiSS.Asystematicreviewoffamilyhistory,race/ethnicity,andgeneticrisk on prostate cancer detection and outcomes: Considerations in PSA-based screening. Urologic Oncol 2025; 43(1):29-40. https://doi.org/10.1016/j.urolonc.2024.06.002
10. Benedict MOA, Steinberg WJ, Claassen FM, Mofolo N. The profile of Black South African men diagnosed with prostate cancer in the Free State, South Africa. S Afr Family Pract 2023;65(1):e1-e10. https://doi.org/10.4102/safp.v65i1.5553
11. RoehrbornCG,BlackLK.Theeconomicburdenofprostatecancer.BJUInt2011;108(6):806-813.https:// doi.org/10.1111/j.1464-410X.2011.10365.x.
12. Sartorius K, Sartorius B, Govender PS, Sharma V, Sherriff A. The future cost of cancer in South Africa: An interdisciplinary cost management strategy. S Afr Med J 2016;106(10):949. https://doi.org/10.7196/ SAMJ.2016.v106i10.11375.
13. MolinierL,CastelliC,BauvinE,etal.CoststudyoftheclinicalmanagementofprostatecancerinFrance: Results on the basis of population-based data. Euro J Health Econo 2011;12(4):363-371. https://doi. org/10.1007/s10198-010-0250-6
14. Chen S, Cao Z, Prettner K, et al. Estimates and projections of the global economic cost of 29 cancers in 204 countries and territories from 2020 to 2050. JAMA Oncol 2023;9(4):465. https://doi.org/10.1001/ jamaoncol.2022.7826
15. Marais B, Klopper G, John J. Prostate cancer perspective: Africa versus the world. S Afr Med J 2024;114(4):e1950. https://doi.org/10.7196/SAMJ.2024.v114i4.1950.
16. Ngcamphalala C, Östensson E, Ginindza TG. The economic burden of prostate cancer in Eswatini. BMC Health Serv Res 2022;22(1):483. https://doi.org/10.1371/journal.pone.0250113.
17. Gabela NC, Bhadree S, Mathibe LJ. Costs of managing castrate-resistant metastatic prostate cancer patients at Inkosi Albert Luthuli Central Hospital. S Afr J Surg 2021;59(4):176-178.
18. National Department of Health. Clinical Guidelines for Prostate Cancer Control and Management. Pretoria: NDoH, 2019.
19. Jo C. Cost-of-illness studies: Concepts, scopes, and methods. Clin Mol Hepatol 2014;20(4):327-337.
https://doi.org/10.3350/cmh.2014.20.4.327
20. Boachie MK, Thsehla E, Immurana M, Kohli-Lynch C, Hofman KJ. Estimating the healthcare cost of overweight and obesity in South Africa. Glob Health Action 2022;15(1):2045092. https://doi.org/10.10 80/16549716.2022.2045092
21. National Cancer Registry. Summary Statistics of cancer diagnosed histologically in 2022. Pretoria: National Health Laboratory Services, 2024.
22. CassimN,AhmadA,WadeeR,RebbeckTR,GlencrossDK,GeorgeJA.Prostatecancerage-standardised incidence increase between 2006 and 2016 in Gauteng Province, South Africa: A laboratory data-based analysis. S Afr Med J 2020;111(1):26. https://doi.org/10.7196/SAMJ.2020.v111i1.14850
23. NationalDepartmentofHealth.MasterHealthProductList.Pretoria:NDoH,2022.
24. National Department of Health, South Africa. Uniform Patient Fee Schedule Annex A6 Oncology.
Pretoria: NDoH, 2022.
25. National Health Laboratory Service, South Africa. NHLS state price list. Johannesburg: NHLS, 2018.
26. National Department of Health, South Africa. Annexure A3 Uniform Patient Fee Schedule. Pretoria:
NDoH, 2022.
27. KrahnMD,ZagorskiB,LaporteA,etal.Healthcarecostsassociatedwithprostatecancer:Estimatesfroma
population-based study. BJU Int 2010;105(3):338-346. https://doi.org/10.1111/j.1464-410X.2009.08758.x 28. MojahedianMM,ToroskiM,KeshavarzK,AghiliM,ZeyghamiS,NikfarS.Estimatingthecostofillness
of prostate cancer in Iran. Clin Ther 2019;41(1):50-58. https://doi.org/10.1016/j.clinthera.2018.11.001 29. Ramutumbu NJ, Ramathuba DU, Maputle MS. Barriers to accessing oncology services for effective cancer care in the public health institutions in Limpopo Province, South Africa: A qualitative study. Nurs
Rep 2023;13(3):956-968. https://doi.org/10.3390/nursrep13030084
30. South African Legal Information Institute. Cancer Alliance v Member of Executive Council for Health
Gauteng Province and Others (2024/071038) (2025) ZAGPJHC 357 (2025) 2 All SA 668 (GJ) (27 March 2025).
Downloads
Published
Issue
Section
License
Copyright (c) 2026 E Thsehla, M Khoza, M K Boachie, W Mdewa, S Goldstein, H Somaroo, K J Hofman
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
