Cost-effectiveness of the Risk Assessment and Management Programme for primary care patients with Hypertension (RAMP-HT) – 3-years of experience

Abstract

Introduction: The cost-effectiveness of primary care programmes encompassing both algorithm-driven cardiovascular diseases(CVD) risk assessment and multi-disciplinary care for patients with hypertension(HT) remains unknown. This study evaluates the cost-effectiveness of the Risk-Assessment-and-Management-Programme(RAMP-HT) for HT patients in Hong Kong. Methodology: A prospective cohort study was conducted for 42,490 RAMP-HT participants and the same number of propensity-score-matched HT patients receiving usual primary care in Hong Kong between October 2011 and March 2013, who were without CVD at baseline. The effectiveness measures were cumulative incidences of all-cause mortality and CVD including coronary heart disease, heart failure and stroke over 3 years. Using a bottom-up approach, the programme costs including set-up costs, ongoing intervention costs and central administrative costs of RAMP-HT were estimated from public health service provider’s perspective. The incremental cost-effectiveness ratios were calculated by dividing the incremental costs by the incremental effectiveness of the RAMP-HT group compared to those of the usual care group. Results: Significantly lower cumulative incidences of any CVD complications(3.6% vs 4.6%,p<0.001) and all-cause mortality(2.1% vs 4.8%,p<0.001) were observed in the RAMP-HT group compared to the usual care group. The 3-year mean programme cost of RAMP-HT was US$52 per participant. The RAMP-HT costed US$5,452 and US$1,973 to reduce one CVD and death over 3 years, respectively. Discussion and conclusion: The RAMP-HT integrated into usual primary care was demonstrated to be cost-effective over 3 years. These findings support structured, algorithm-driven CVD risk assessment and multi-disciplinary care in routine primary care for all HT patients to prevent CVD/death and reduce healthcare burden.