A 10-year costing analysis of the Risk Management and Assessment Programme for primary care patients with diabetes mellitus in Hong Kong

Abstract

Introduction: Economic evaluation of healthcare programmes has important policy implications on directing resource allocation for chronic disease management. The Risk Management and Assessment Programme – Diabetes Mellitus (RAMP-DM) is a protocoldriven, multicomponent and interdisciplinary programme for diabetes care implemented in public primary care. This study aims to estimate the total and annualized costs at the patient-level for RAMP-DM over 10 years. Methods: A costing analysis using data collected from surveys and the Hospital Authority (HA) Clinical Management System was conducted retrospectively at the cluster and clinic (2 per cluster) levels from all seven HA clusters, and the HA Head Office. Direct costs incurred between 1st April 2009 and 31st March 2019 were collected using a micro-costing approach, where the type and resources used for implementation and delivery of RAMP-DM were recorded. Costs were estimated from the healthcare provider perspective, and partitioned into fixed and ongoing costs. Fixed-cost are costs incurred for setting up and maintenance of the program, including personnel training, equipment and infrastructure. Ongoing costs for delivering RAMP-DM services was determined based on the duration of interventions and resources used. Results: A total of 387,904 patients were enrolled in RAMP-DM over 10 years. The average total program cost for RAMP-DM over 10 years was HK$2,715 (range: $1,469-4,910) per patient. This estimate was based on HK$110 ($92-433; 4%) in fixed costs, HK$1,939 ($1,244-2,787; 71%) in ongoing RAMP-DM service costs and HK$666 ($133-1,690; 25%) in administrative costs. The average unit cost per RAMP-DM intervention per patient was HK$225 ($188-250), of which personnel costs accounted for 94-97% of total costs per intervention. Conclusions: Detailed cost information is essential for understanding the levels and types of resources necessary for implementation, and upkeeping of RAMP-DM or similar chronic disease management programs in the future. The results will directly input into a cost-effectiveness analysis for RAMP-DM.