Cost-effectiveness of the multi-disciplinary Risk Assessment and Management Programme for primary care patients with Hypertension (RAMP-HT) – 5-year Programme Experience

Abstract

Background: The protocol-driven multi-disciplinary Risk-Assessment-and-Management-Programme for patients with hypertension (RAMP-HT) in Hong Kong (HK) has been proven to enhance blood pressure(BP) control and reduce predicted risk of cardiovascular disease (CVD) complications in a 12-months follow-up study. Nevertheless, long-term cost-effectiveness of such programme is unknown. This study aimed to evaluate the 5-year cost-effectiveness of the RAMP-HT. Methods: A population-based prospective cohort study was conducted for 34,542 RAMP-HT participants matched with 34,542 HT patients receiving usual public primary care in HK between October 2011 and March 2013 using propensity-score-method; all subjected were aged ≥18 and without prior clinical diagnosis of CVD or end-stage renal disease(ESRD). RAMP-HT effectiveness was evaluated by the 5-year cumulative incidence of developing CVD, ESRD and all-cause mortality. The average RAMP-HT cost per participant was calculated by the sum of set-up cost, on-going administrative cost, and the number of RAMP-HT intervention used times unit cost. RAMP-HT cost-effectiveness was determined by Incremental-Cost-Effectiveness Ratio(ICER) for each event prevented. Results: RAMP-HT participants had significantly lower cumulative incidences of CVD (7.9% vs 12.5%, p<0.001), ESRD(1.0% vs 1.7%, p<0.001) and all-cause mortality(4.1% vs 8.7%, p<0.001), compared to the usual care group. The average intervention cost of RAMP-HT was US$66 per participant over 5 years. The RAMP-HT costed US$1,447, US$9,742 and US$1,447 to reduce one CVD, ESRD and death over 5 years, respectively. Conclusion: Our findings showed that the RAMP-HT was cost-effective after 5 years’ follow-up and supported the routine use of RAMP-HT-enhanced usual primary care to prevent HT-related complications, mortality and reduce healthcare burden.