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4.3.3  THE CASE FOR SCREENING AND MANAGEMENT OF
                    DM IN HONG KONG

            In considering the growing burden of DM, with rapidly increasing prevalence, decreasing age
            of onset, and projected growth in disease and economic burden, there is a strong case
            for developing a comprehensive screening and management programme
            to identify individuals at risk of and already with DM, and to provide
            timely intervention. More specifically, screening and management efforts must be
            tailored to: i) identify and prevent patients with no DM from progressing into prediabetes
            cases; ii) prevent prediabetes cases from progressing into DM cases; and iii) reduce and/or
            delay DM-related disease complications, including mortality. Similar to previously published
            care protocols, these combined efforts aim to prevent and/or delay DM diagnoses and
            subsequent DM-related complications so that patients may enjoy a greater number of healthy
            years and reduce high spending on health service utilisation (Fung et al., 2012).


            Our study seeks to inform the design of the Chronic Disease Screening Voucher and
            Management Scheme by using a thirty-year prospective screening and
            management programme for DM as a proxy, for those aged 45 to 54 years, based
            on recommendations from Food and Health Bureau’s guidelines (2018) on DM. We address
            this pilot scheme as the “Scheme” in this chapter. In the Scheme, enrolled individuals will
            receive DM screening and/or management within the private sector, with patients requiring
            more complex secondary and tertiary care (e.g. inpatient care) being referred back to the
            public sector for care and treatment. More details on the clinical definition, screening,
            diagnostic tests, and management guidelines are presented in Appendix M.

            On an ongoing continuum and as part of the project funded under the Public Policy
            Research Funding Scheme of the Policy Innovation and Co-ordination Office (PICO) in the
            HKSARG (Project number: 2020.A4.068.20B), a Cost-Effectiveness Analysis (CEA) model for
            each of the three prevalent chronic conditions in Hong Kong, namely DM, hypertension, and
            hyperlipidemia, has been conducted to understand the cost-effectiveness of screening. Data
            and findings from the CEA suggest that population-wide screening, namely for those
            between the ages of 45–64 years, is a cost-effective measure for improving population
            health through life-years and complication treatment saved. Hence, we believe that additional
            analysis needs to be conducted to complement findings from the CEA to better inform public
            opinion and policy efforts.

            Here, we estimate the financial impact of the Scheme on Hong Kong’s health system
            spending on DM care through a Budget Impact Analysis (BIA) using Hong Kong
            and relevant international data to generate more robust evidence on projected
            expenditure and savings. The BIA will have important implications on the potential
            implementation of the Scheme in Hong Kong, and in particular, will offer insight into how
            such programmes may impact the financial budget in the short- and long-term.
























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