Economic burden of leukemia diagnosis and treatment in South Africa: A retrospective cost of illness analysis

Abstract

BACKGROUND: Globally, leukemia is a substanial cause of morbidity and mortality, imposing a significant economic burden on the healthcare system, patients, and society. However, evidence on the societal costs of leukemia in low- and middle-income countries, remains limited. This study estimated the economic burden of leukemia diagnosis and treatment in South Africa over the first 12 months following diagnosis. METHODS: A cost of illness study using a 12-month time horizon from diagnosis was conducted from a limited societal perspective. A bottom-up, incidence-based micro-costing approach was used to estimated direct medical costs (diagnosis, treatment, and follow-up) and indirect costs (premature mortality, absenteeism, and informal care). Deterministic sensitivity analyses were performed to assess parameter uncertainty and the robustness of results. RESULTS: The total annual economic burden of leukemia was estimated at $6 million, comprising $4.5 million in direct costs and $1.4 million in indirect costs. Treatment costs were the primary driver of direct expenditure, followed by diagnostics and consultations. Average annual costs per patient during the first 12 months after diagnosis ranged from $30,864 for acute lymphoblastic leukemia to $8056 for chronic lymphocytic leukemia. Productivity losses due to premature mortality were the main contributor to indirect costs. Direct costs accounted for 76.4% of total costs, ∼0.03% of national healthcare expenditure. CONCLUSION: Leukemia management is associated with substantial early treatment-related costs in South Africa, reflecting the intensity and complexity of care required across subtypes. Understanding these cost drivers is important for informing clinical resource allocation, optimizing treatment pathways, and strengthening hematology service planning in resource-constrained settings. Strategies to improve timely diagnosis, appropriate treatment selection, and access to essential therapies may contribute to more sustainable leukemia care delivery.