Discrete event simulation of private and public comprehensive breast care clinics in South Africa ? a case study exploring the economics of stepwise implementation of breast care improvements and resource pooling

Breast cancer is the most commonly diagnosed cancer worldwide, with an estimated 2.3 million new cases globally and an incidence of 50.4 per 100,000 in Southern Africa in 2020. Breast cancer incidence rates in sub-Saharan Africa increased rapidly. This study will use a discrete event simulation approach to determine and explore the impact of health systems constraints on breast cancer care in South Africa. We will estimate the costs from a payer's perspective and the cost-effectiveness of constraints relaxation required to reduce health system delays in diagnosing and treating breast cancer. We will use 2 breast care clinics, a public and private clinic in Johannesburg, South Africa, as case studies. In light of the rollout of universal health coverage through the National Health Insurance (NHI), the study will also test how a collaborative community approach (where public and private sector providers work together to achieve common objectives and outcomes and improve health system performance) can result in technical efficiency through resource and risk pooling.