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The Cadenza study estimated the attributable medical cost to DM in the
public sector, in particular for: inpatient care (bed days), General Out-Patient Clinics
(GOPCs), Specialist Out-Patient Clinics (SOPCs), and Accident & Emergency Department
(A&E). Firstly, the attributable medical costs of DM in the public sector for
people aged 65 and above was approximately HKD 1.4 billion in the year
2006, which includes direct costs such as inpatient care in public hospitals and costs of
doctor consultations (HKJC, 2009). The study also estimated that the number of people
aged 65 and above who had DM was approximately 0.11 million in 2004,
marking an increase of 23.3% from 0.09 million in 2000 (HKJC, 2009). The increase of 23%
in number of patients aged 65 and over with DM is especially concerning due to the scope
and the high cost per patient, which was valued at roughly HKD 11,915 amongst those 65
and over. Finally, the study further projected future attributable medical costs to DM in the
public sector for those aged 65 and above in 2036. Based on previous estimates and 2006
prices, the study estimated attributable medical costs at HKD 3.5 billion in
2036, projecting an increase of 163% in costs compared with that in 2006.

However, the Cadenza study has cited the above calculations as a conservative estimate of
costs, despite the projected increase in years to come (HKJC, 2009). In view of the growing
disease and economic burden of DM in Hong Kong and its public healthcare system as
detailed by the Cadenza study, it is critical to identify and evaluate the availability of effective
prevention and management for DM in Hong Kong. This study will expand upon the findings
of the Cadenza study to assess the financial impact of screening over a prospective 30-year
time horizon.

iii. The cost-effectiveness of DM prevention and management in
Hong Kong

Over the past two decades, there have been several studies evaluating different interventions
for DM care in Hong Kong. At the forefront of such clinical practices has been the Risk
Assessment and Management Programme for Diabetes Mellitus (RAMP-DM).
In 2009, the Hospital Authority (HA) launched the territory-wide programme as an effort to
improve the quality of care provided to patients receiving DM care in all 73 public primary
care clinics at the HA’s GOPCs (Chan et al., 2019). Patients with DM attending GOPCs were
invited at random to enrol in RAMP-DM.

The general goal of care for patients with DM is to prevent DM-related complications.
Therefore, the RAMP-DM care model sets itself apart from the “usual care” protocol by
incorporating risk assessment criteria for risk level stratification, which is used
to administer tailored care plans with risk-appropriate intervention and education by a team
of multi-disciplinary healthcare professionals (for more details of the two care protocols, see
Table 4.7).

Participants are stratified into four groups, namely “very high risk”, “high-risk”, “medium risk”,
or “low risk”, from which care plans are developed according to a standardised risk-stratified
guide. Traditionally, patients deemed low-risk will continue receiving usual GOPC care, while
medium-risk patients are provided with additional intervention by an advanced practice nurse
(APN) (Fung et al., 2012). High-and very high-risk patients are provided with additional
interventions by an APN and an associate consultant who specialises in family medicine.

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