Cost-effectiveness of the Risk Assessment and Management Programme for primary care patient with Hypertension (RAMP-HT)

Abstract

Problem: The Risk Assessment and Management Programme - Hypertension (RAMP-HT) is a territory-wide, multidisciplinary, multi-component intervention added onto usual primary care that provides total cardiovascular disease risk management of hypertensive patients. It has proven effectiveness in reducing hypertension-related complications and mortality among hypertensive patients after 5 years, thus potentially lessening healthcare burden. However, the sustainability of programme benefit remains unknown. This study aims to evaluate the cost-effectiveness of the RAMP-HT over lifetime. Approach: A lifetime cost-effectiveness analysis from health service provider’s perspective was conducted using Markov modelling. Empirical data from a propensity-score-matched cohort of 79,161 RAMP-HT participants and 79,161 usual primary care patients with hypertension was used to estimate public direct medical costs and gender-specific annual transition probabilities of developing hypertension-related complications, including coronary heart disease, stroke, heart failure and end stage renal disease. The mortality of patients with specific hypertension-related complications was estimated from a cohort of 327,842 primary care patients with hypertension. Private direct medical costs and health preference of hypertensive patients with different complication status were collected through structured questionnaire survey of 486 and 873 patients, respectively. Incremental cost‐effectiveness ratios 54 (ICER) was calculated by the ratio difference of direct medical cost to difference of quality-adjusted-life-year (QALY) gained between RAMP-HT participants and usual care patients. Probabilistic sensitivity analysis was conducted with results presented as a cost‐ effectiveness acceptability curve. Findings: A RAMP-HT participant was estimated to save US$714 (US$43,340 vs. US$44,054), gain 0.20 QALYs (12.49 QALYs vs 12.29 QALYs) and 0.19 life years (LYs) (14.64 LYs vs. 14.45 LYs), compared to a patient received usual care on average. The probabilistic sensitivity analysis found that RAMP-HT had 100% chance of being cost-saving compared to usual care under the assumptions and estimates used in the model. Hence, RAMP-HT was proved to be a cost-saving intervention dominating usual care, regardless of the willingness-to-pay threshold. The positive effect of RAMP-HT was shown to be greater if the duration of the intervention lasted longer. Consequences: RAMP-HT was projected to be a cost-saving intervention compared to usual care in preventing hypertension-related complications and mortality over the lifespan of a hypertensive patient. The significant reduction in mortalities, complications and resultant direct medical costs could be attributed to the team-based approach facilitated by an improved electronic information-relay system, which ensured delivery of holistic cardiovascular disease risk management, enhanced coordination of allied health services and maximized use of doctor consultation time. In view of the clinical and financial benefits, RAMP-HT should be integrated into usual primary care to enhance management of hypertensive patients. Further study should be conducted to inform who will benefit most from and the optimal frequency of repeating the RAMP-HT intervention. Funding Acknowledgement: This study was funded by the Health and Medical Research Fund, Food and Health Bureau, HKSAR (Project no: 13142471).