Cost-effectiveness of multidisciplinary Risk Assessment and Management Programme for primary care patients with Hypertension

Abstract

Context: The protocol-driven multi-disciplinary Risk Assessment and Management Programme for Hypertension(RAMP-HT) in Hong Kong(HK) was demonstrated to significantly reduce participants’ blood pressure and low-density-lipoprotein-cholesterol after 12 months compared to patients receiving usual primary care. Yet long-term cost-effectiveness of RAMP-HT remains unknown. Objective: To evaluate 5-year cost-effectiveness of RAMP-HT. Study Design: Prospective cohort study. Setting or Dataset: Electronic health records of all primary care patients with hypertension(HT) from HK Hospital Authority. Population studied: HT patients aged≥18 without diabetes, cardiovascular diseases(CVD) or end-stage renal disease(ESRD) who had been managed in any of 74 public primary care clinics in HK between 2011-2013 were included. 79,161 RAMP-HT participants were propensity-score matched to same number of HT patients receiving usual primary care. Intervention/Instrument: RAMP-HT launched in all public primary care clinics in HK. Outcome Measures: Primary outcome was cost-effectiveness of RAMP-HT in terms of RAMP-HT programme cost per CVD, ESRD or all-cause mortality event prevented. Secondary outcomes were cumulative incidences of CVD, ESRD and all-cause mortality, and public direct medical cost consumed by RAMP-HT participants compared to usual care patients over 5 years. Results: After median follow-up of 5.3 years, RAMP-HT participants had significantly lower cumulative incidences of CVD(9.1% vs. 15.0%, p<0.001), ESRD(0.9% vs. 1.6%, p<0.001) and all-cause mortality(5.0% vs. 11.0%, p<0.001), compared to HT patients receiving usual primary care. NNT of RAMP-HT to reduce one CVD, ESRD and all-cause mortality were 17, 155, and 20 respectively. The RAMP-HT programme costed US$67 per participant over 5 years, thus US$1,161, US$10,361 and US$1,326 to reduce one CVD, ESRD and death, respectively. Conversely, the average 5-year public direct medical cost per RAMP-HT participant was significantly lower than usual care patient (US$7,399 vs. US$11,276, p<0.001), due to reduced over-night hospitalization, emergency department and specialist clinic visits. The RAMP-HT served 120,054 HT patients in 2011-2013 and saved US$457 million of public medical cost over 5 years. Conclusion: The RAMP-HT was proven effective and cost-saving after 5 years’ follow-up; such care model could enhance usual primary care for HT patients to prevent HT-related complications, mortality and reduce healthcare burden.