Page 193 - 20211214_OHKF_Health_Finance_Research_Report_E (1)

While this screening mechanism veers away from the screening guidelines, this protocol
more closely aligns with the services available in the private sector for DM screening. During
an initial assessment of the DM screening services in the private sector, we found that many
clinics offered DM tests in various combinations, rather than individual tests. In particular,
given that patients may not have the luxury of visiting clinics in high frequency to conduct
different DM testing and given that a blood sample is required for both the HbA1c and FPG
tests, conducting both tests simultaneously as a “first-round” screening is more efficient and
ensures more accurate results (Appendix S).

Cost of screening is premised on assumptions about market
behaviour and economies of scale

Our modelling approach for the overall cost of screening also presumes shifts in costs to the
health system upon implementation on a population-scale. Currently, we assume an average
total cost of screening per individual to be HKD 200 per screening event, indicating that
regardless of the combination of tests that a patient receives, the average cost per patient
per screening will be approximately HKD 200. We note that such a low average total cost
may currently fall below the average cost of screening in the private sector, where the median
price for screening services involving FPG, HbA1c, and OGTT is approximately HKD 400–650
per patient.

Nonetheless, in considering that the health system will play a central role in organising the
screening efforts to ensure a high quality standard, it is not improbable that conducting
population-wide screening may allow the health system to achieve economies of scale, thus
lowering the cost of screening for all. Such reductions in cost are not unprecedented in the
health system, most notably with the reduction of costs for COVID-19 testing during the last
quarter of 2020, when the Government launched four community testing centres (HKSARG,
2020a). This example of cost reduction is indicative of the lower costs achievable through the
centralisation and mass implementation of services by the Government and health system.

The modelling mechanisms additionally acknowledge that individuals without DM will face
different screening needs and receive varied recommendations for rescreening. The current
dearth of data relating to the percentage of individuals deemed high-risk for DM creates a
gap in our ability to fully forecast screening costs to the health system. To work around this
data gap, we instead used data pertaining to physical activity during a normal week, taking
the average percentage of individuals in each age group who reported having engaged in
moderate or vigorous physical exercise. We used this value as a proxy for individuals at
low-risk for DM due to their healthy lifestyle habits that would form a significant component
of the recommendations for those at high-risk. Individuals categorised as low-risk will receive
screening services every three years, or as recommended by their doctors, while high-risk
individuals and individuals with prediabetes will receive screening services on an annual
basis (FHB, 2018).

191