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While both iterations of the Scheme suggest cost-savings under the parameters of the BIA
model, we acknowledge that in absolute values, it would appear more financially responsible
to implement only a screening voucher due to its higher cost-savings compared to a full
screening and management Scheme. However, cost-savings as an absolute value is not fully
indicative of the cost-efficiency of the Scheme iterations. The benefits of the full Scheme, as
encapsulated by Scenario 2, can be shown by i) the number of prevented mortalities from
DM, and ii) the cost to prevent one mortality.

When considering i) the number of prevented mortalities, Scenario 2 observed larger
decreases in total mortality of individuals due to DM than Scenario 1. The model projects that
implementing a screening-only voucher Scheme would prevent 28,742
total mortalities due to DM and prediabetes. When both the screening voucher
and management Scheme are implemented, the model projects that
47,138 total mortalities will be prevented (Figure 4.13). Overall, there are more
prevented mortalities in Scenario 2 than in Scenario 1.

When considering ii) the cost to prevent one mortality, our analyses show that Scenario 2
projects a lower cost to prevent one mortality than Scenario 1. In Scenario 1, the model
projects the cost to prevent one mortality in the event of implementing only a screening
voucher to be HKD 1,091,190.59. In comparison, our model projects that the cost to
prevent one mortality should a screening voucher and management Scheme be
implemented is HKD 696,794.93, showcasing a 36.1% decrease in spending per
mortality relative to Scenario 1. In short, the approximately 3% extra spending
over the course of a 30-year timeline will prevent an extra 20,000
mortalities. Hence, while implementing a screening only voucher Scheme may incur less
spending in the long-term, we consider it more financially reasonable to implement a
screening voucher and management scheme to utilise spending more efficiently.

Furthermore, these projected figures only account for direct spending to the health system
through hospitalisations, medication, and consultations with doctors. However, our model
cannot fully account for the indirect benefits that are likely to be accrued from
the implementation of the Scheme. For instance, we project that implementing the Scheme
in full would result in prevented mortalities from individuals with DM. While we must account
for their continued healthcare spending, we cannot account for their later economic
contributions through continued employment, participation in the community, or role in
supporting their families as a result of prevented mortality. Similarly, in the case of the Base
Scenario of the status quo, we cannot fully account for the economic impact on patients’
families and communities if they develop severe complications that take away from their
ability to contribute economically nor the financial impact on family members who experience
the loss of a loved one. As such, we maintain that while our projections showcase the likely
financial impact on the health system, we have likely underestimated the actual
economic and interpersonal benefits to patients, their communities, and
the larger Hong Kong primary healthcare ecosystem.

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