The burden of leukemia in South Africa: epidemiological trends, economic impact, and priority setting

Woudberg, Rochelle

The burden of leukemia in South Africa: epidemiological trends, economic impact, and priority setting

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Background Leukemia is a malignant disorder characterized by the proliferation of abnormal blood cells in the white blood cells in the bone marrow and bloodstream. Globally, it presents a significant economic burden to the healthcare system, patients, and society. Despite the substantial impact of leukemia, data on its epidemiology, economic burden, and the cost-effectiveness of treatment options are scarce and outdated. This thesis aimed to address these gaps by exploring leukemia's burden, evaluating the cost-effectiveness of treatment strategies, and developing a priority-setting framework tailored to the South African context. Methods This thesis utilized a mixed method approach, including literature review, retrospective descriptive analysis, micro-costing modelling, and decision analysis modelling. Epidemiological data from the South African National Cancer Registry and Statistics South Africa were analyzed to determine incidence, mortality, and the disease burden of leukemia. A cost of illness study was conducted to estimate the economic burden of leukemia diagnosis and treatment from a limited societal perspective, using a micro-costing, bottom-up incidence-based approach. Markov models were used to evaluate the cost-effectiveness of treatment strategies for chronic leukemias, with outcomes reported in total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to determine the robustness of the model outcomes. A modified Delphi was used to identify leukemia care priorities and rank improvement and research priorities within the South African healthcare system. Results The epidemiological analysis revealed increasing leukemia incidence rates in South Africa, accompanied by modest declines in mortality and disability-adjusted life years (DALYs). The cost-of-illness study estimated the annual economic burden of leukemia at $5.9 million in 2019, with an estimated $4.5 million in direct costs and $1.4 million in indirect costs. Direct costs made up 76.4% of healthcare costs, of which treatment costs were the primary driver of direct healthcare expenditure. The cost-effectiveness analysis for CML indicated that imatinib was the most cost-effective first-line treatment providing the lowest cost at $120 719.55 and providing 5.93 QALYs. For CLL, targeted therapies like ibrutinib were showed higher effectiveness, however incurred greater costs compared to chemoimmunotherapy, emphasizing the need for sustainable pricing strategies. The Delphi study identified 67 priority statements and ranked 17 improvement and research priorities, emphasizing timely diagnosis and biomarker development as top priorities. Conclusion This thesis provides a comprehensive evaluation of leukemia in South Africa, providing insights into the epidemiological trends, economic burden, and cost-effectiveness of leukemia treatment strategies, while also offering a consensus-driven framework for improving leukemia care. These findings highlight the need for sustained efforts to improve leukemia detection, pricing strategies, access to targeted therapies, optimizing resource allocation and healthcare quality in South Africa.

Keywords

leukemia

economic impact

Reference:

Collections

PhD / Doctoral

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