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Cost-effectiveness of a primary care multidisciplinary Risk Assessment and Management Program for patients with diabetes mellitus (RAMP-DM) over lifetime

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Abstract

Purpose

The multidisciplinary Risk Assessment and Management Program for patients with diabetes mellitus (RAMP-DM) was found to be cost-saving in comparison with usual primary care over 5 years’ follow-up. This study aimed to estimate the cost-effectiveness of RAMP-DM over lifetime.

Methods

We built a Discrete Event Simulation model to evaluate the cost-effectiveness of RAMP-DM over lifespan from public health service provider’s perspective. Transition probabilities among disease states were extrapolated from a cohort of 17,140 propensity score matched participants in RAMP-DM and those under usual primary care over 5-year’s follow-up. The mortality of patients with specific DM-related complications was estimated from a cohort of 206,238 patients with diabetes. Health preference and direct medical costs of DM patients referred to our previous studies among Chinese DM patients.

Results

RAMP-DM individuals gained 0.745 QALYs and cost US$1404 less than those under usual care. The probabilistic sensitivity analysis found that RAMP-DM had 86.0% chance of being cost-saving compared to usual care under the assumptions and estimates used in the model. The probability of RAMP-DM being cost-effective compared to usual care would be over 99%, when the willingness to pay threshold is HK$20,000 (US$ 2564) or higher.

Conclusion

RAMP-DM added to usual primary care was cost-saving in managing people with diabetes over lifetime. These findings support the integration of RAMP-DM as part of routine primary care for all patients with diabetes.

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Acknowledgements

The authors wish to acknowledge the contributions of the RAMP-DM program teams and Statistics and Workforce Planning Department at the Hong Kong Hospital Authority. Also, we would like to thank all hospital authority cluster coordinators and clinical staff in the Chronic Disease Management Programs for working with our team in this study.

Author contributions

F.J. and C.L.K.L. initially conceived the concept of this study. C.S.C.F. and E.Y.F.W. were responsible for data collection. F.J., E.Y.F.W., and A.K.C.C.M. performed the statistical analysis. F.J. drafted the article. All the authors made substantial contribution to the interpretation of data and revised the manuscript for important intellectual content. F.J. and C.S.C.F. take responsibility for the contents of the article.

Funding

This study was funded by the Health and Medical Research Fund, Food and Health Bureau, HKSAR Commissioned Research on Enhanced Primary Care Study (Ref. no: EPC-HKU-2). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F., 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong, Hong Kong

    Fangfang Jiao, Eric Yuk Fai Wan, Colman Siu Cheung Fung, Anca Ka Chun Chan & Cindy Lo Kuen Lam

  2. School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, William MW Mong Block, 21 Sassoon Road, Hong Kong, Hong Kong

    Sarah Morag McGhee

  3. Primary and Community Services, Hospital Authority Head Office, Hong Kong Hospital Authority, Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong, Hong Kong

    Ruby Lai Ping Kwok

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  1. Fangfang Jiao
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  2. Eric Yuk Fai Wan
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  3. Colman Siu Cheung Fung
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  4. Anca Ka Chun Chan
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Corresponding author

Correspondence to Eric Yuk Fai Wan.

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The authors declare that they have no conflict of interest.

Informed consent

While this study involving human participants, all data of the patients were anonymous and extracted by the administrative electronic health record system. Hence, no informed consent of the participants was required in this study.

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Jiao, F., Wan, E.Y.F., Fung, C.S.C. et al. Cost-effectiveness of a primary care multidisciplinary Risk Assessment and Management Program for patients with diabetes mellitus (RAMP-DM) over lifetime. Endocrine 63, 259–269 (2019). https://doi.org/10.1007/s12020-018-1727-9

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