Economic Analysis of Hong Kong’s Efforts to Enhance Primary Care Management of Diabetes

Abstract

Primary care is the regular point of contact for chronic disease management and is easily accessible to the majority of the population. A Working Group on Primary Care chaired by the Secretary for Food and Health issued a strategic policy framework to enhance and develop primary care in Hong Kong. The strategy recommends a conceptual model for the management of chronic disease using a population life-course approach. This “population approach” sets specific targets on body weight, smoking cessation, glucose control, and blood pressure control to reduce the risks across the entire population. A small shift in the average population levels of several risk factors can lead to a large reduction in the disease burden and economic savings. We analysed panel data of over 700,000 people with diabetes covering publicly provided health care services in Hong Kong. We studied the effects of achieving best clinical practice, ranging from no change to achieving “acceptable” and “ideal” scenarios under the Hong Kong policy framework. Using validated risk models for Chinese people with diabetes, we estimate that achieving the acceptable target range for diabetes leads to an average absolute risk reduction of 1.26% in mortality over five years. If the ideal primary care targets for diabetes management are achieved, the absolute risk reduction for mortality at five-years is 2.49%. Applying a value of a life-year at US$ 200,000 and a discount rate of 3%, corresponds to an economic value of US$ 5,905 (acceptable scenario) to US$ 11,650 (ideal scenario) per person with diabetes over a five-year period. Given the high prevalence of diabetes in the population, this translates into large economic benefits (millions of US dollars) from improved primary care management. We also found reductions in the five-year incidence of ischaemic heart disease (1.24%-2.48%), and cerebrovascular disease (0.71%-1.11%), which results in an average reduction in direct medical treatments costs of US$ 75-199 per person with diabetes. Risk reductions and cost savings were greater for females compared to males, and among the older age groups. Enhancing primary care is a pressing concern as the population ages and develops a greater burden of chronic diseases such as diabetes. A strategic policy framework that results in small shifts in the average risk factor levels in the diabetes population can lead to large economic benefits.