INTRODUCTION:
Low and middle-resource settings have experienced growth in cancer survivorship, driven by increasing access to diagnosis and treatment (1). This shift has heightened the importance of understanding the long-term management needs of cancer survivors. However, evidence on the costs associated with post treatment follow-up remains limited in South Africa. Generating such evidence is crucial for informing efficient resource allocation and supporting sustainable, long-term cancer care planning within the public health sector. This study aimed to estimate the cost of five-year post-treatment follow-up for colon cancer patients, stratified by baseline stage, from the healthcare provider's perspective at a public tertiary hospital in South Africa.

METHODS:
Follow-up components were defined based on facility guidelines and verified through expert interviews, linking these components to relevant cost items. Second, a bottom-up costing method was used to estimate the per-patient five-year follow-up costs for each stage. All capital items were annuitised using a rate of 3%, and sensitivity analyses were conducted. All costs are reported in South African Rands (ZAR) and United States Dollars (USD) as per 2024 average exchange rates of 1USD=18.5 ZAR (2).

RESULTS:
Mean five-year follow-up costs increased with advancing stage. Estimated per-patient follow-up costs were ZAR 17785 (USD 961) for Stage I, ZAR 20596 (USD 1113) for Stage II, ZAR 23407 (USD 1265) for Stage III, and ZAR 51406 (USD 2780) for Stage IV disease.

CONCLUSIONS:
Follow-up for colon cancer represents a significant cost burden within South Africa’s public healthcare system. Costs rise markedly with cancer stage, highlighting the importance of early detection and efficient survivorship care planning. These findings provide empirical evidence to support the development of cost-conscious follow-up strategies and inform resource allocation for cancer survivorship care in resource-constrained settings.