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Factors that may impact costs to the health system

To counter potential concerns surrounding data, we additionally conducted various univariate
and multivariate scenario analyses to assess the impact of different parameter values on the
cost-savings and health benefits of conducting the Scheme. We conclude that variations in
parameter values will shift the expected percentage cost-savings, and in certain instances,
the total prevented mortality. Nonetheless, we still find that most variations result in positive
cost-savings and health benefits to the health system.

i) Remission rates

Given that DM remission research is relatively novel in Asia, and especially in Hong Kong, we
assessed the impact of alternative remission rates on cost-savings based on the literature.
We found that a remission rate of 2.0%, based on a population using only DM support and
education, would result in net negative savings, adding an additional HKD 3.819 billion to the
health system spending over a 30-year horizon for the Scheme (Gregg et al., 2012).
Nonetheless, even if the health system expects to increase its spending by 8.42% over a
30-year time horizon, our model still projects a total of 42,633 prevented premature
mortalities. Hence, when only considering the direct costs to the health system, we may
expect higher costs to the health system if a lower remission rate is achieved. Nonetheless,
in considering the demographic benefits of implementing the Scheme, our model still
projects a high number of prevented mortalities.

ii) Cost of screening

In addition, we also assessed the cost impact of a higher total cost of screening per
individual, under the possibility that the Government is unable to significantly lower the
screening cost. We found that a screening cost of approximately HKD 780 will lead to no
cost-savings in the Scheme implementation, while an increase in screening cost from the
current HKD 200 to HKD 445, the cost to the health system for a GOPC attendance, will
result in only a 16.19% cost-saving percentage over the time horizon. We acknowledge that
the screening cost can drive the final cost-savings of the programme, hence pointing to
the critical importance of the role of the Government and health system
planners in achieving lower cost screening services. We believe that it is
possible to do so if population-wide screening were to take place, as the increase in
screening demand could enable the health system to achieve economies of scale.

iii) Cost of implementation

Within the realm of RAMP-DM implementation, we also acknowledge that the costs of
implementation in the public sector may be lower than costs in the private sector. Therefore,
we also assessed the impact of increasing RAMP-DM administrative and implementation
costs. The current model supposes a cost of HKD 244 per patient per year, derived from the
most recent cost-effectiveness study of RAMP-DM, which results in a final cost-savings
percentage of 27.57% (Jiao et al., 2018). When this cost per patient is increased to HKD 500,
the percentage of cost-savings decreases to 26.61%; at HKD 1,000/patient, the percentage
falls to 24.74%; and at HKD 1,500/patient, the percentage becomes 22.87%. This suggests
that while the cost of RAMP-DM implementation may impact the final percentage
cost-savings, it does not appear to be a significant driver of the results. Therefore,
the Government has more leeway in adjusting the price of RAMP
administration to incentivise more private sector participation.

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