Childhood cancers in a section of the South African private health sector: Analysis of medicines claims data

Abstract

Background: Although childhood cancers are rare, increases in incidence have been observed in recent times. There is a paucity of data on the current incidence of childhood cancers in South Africa.Aim: This study described the epidemiology of childhood cancers in a section of the private health sector of South Africa, using medicines claims data.Setting: This study was designed on a nationally representative medicine claims database.Method: A longitudinal open-cohort study employing children younger than 19 years and diagnosed with cancers between 2008 and 2017 was conducted using medicine claims data from a South African Pharmaceutical Benefit Management company. Cases were identified using International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes C00 to C97, together with a medicine claim reimbursed from oncology benefits. Crude incidence rates were calculated per million persons younger than 19 years on the database and standardised using the Segi 1960 world population. Temporal trends in incidence rates, analysed using the joinpoint regression, were reported as annual percentage changes (APCs).Results: Overall, 173 new cases of childhood cancers were identified in the database, translating into an age-standardised incidence rate (ASR) of 82.3 per million. Annual incidence of cancer decreased from 76.7 per million in 2008 to 58.2 per million in 2017. More incident cases were identified in males (68.8%). The highest proportion of incident cases was recorded for leukaemias (39.9%), the 5–9 year age group (34.1%) and the Gauteng Province (49.7%).Conclusion: The incidence of childhood cancers decreased over time in the section of the private health sector studied. Leukaemias were the major drivers of childhood cancer incidence.

The scope of childhood cancer in South Africa: A response to ‘Childhood cancers in a section of the South African private health sector – Analysis of medicines claims data’

“…The private medical aid coverage for the under 18-years age group has been reported to be 9.5% and for the under 6 years age group 3.5% (Omotoso & Koch 2017 :575; Van den Heever 2012 :S5). It is possible that the percentage of medical aid claims that are because of childhood cancer is far lower than reported in the Otoo et al ( 2020 ) study. Considering the representation of the database (less than 50% of medical aid claims) used in the study, the conclusions are only applicable to less than 10% of the childhood malignancies in South Africa.…”

“…The original study partially acknowledged the limitations that the study was based on a single PBM database analysis, that there are discrepancies in incidences and the diverse way in which medical accounts are paid, but still maintained that the data could be used for policy purposes (Otoo et al 2020 :a1382). In addition, two important limitations of the study are that it does not indicate if the patients were newly diagnosed during the study period and the ‘medicine claims’ on which data extraction was based, were never defined.…”

“…The implication is that patient (encrypted) numbers may change. Although not the only data collected, this was the primary indicator used in their study (Otoo et al 2020 :a1382). Cancer treatment is done over years, which limits the age of a patients as a reliable identifier.…”

“…The medicines claims of the South African private health sector was analysed by Otoo et al ( 2020 :a1382) based on a database of a single South African Pharmaceutical Benefit Management (PBM) company. The market share of the PBM was not included but covered 1.8 million beneficiaries.…”

“…As stated in the article, data are used to develop cancer control strategies, evaluate changes in disease burden, and implement policies (Otoo et al 2020 :a1382). Most importantly, data informs the policy.…”