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APPENDIX O: DESCRIPTION OF SCENARIO DIFFERENCES

Base Scenario

To model the demographic changes in the target population, the Base Scenario measures
the flow of DM through progression from a “healthy” population (e.g., a patient without
pre-diabetes or DM), to a population with pre-diabetes, to a population with DM, as well as
regression from pre-diabetes to no DM. Within the Base Scenario, we do not account for the
remission from DM to pre-diabetes due to a lack of intervention for DM patients that would
result in improvement of condition. Mortality was accounted for in all three disease states
using mortality rates due to comorbidity with DM and the latest available mortality rates for
the age group of 45–54 years. Mortality rates for all-cause mortality (as defined by the
Census and Statistics Department of the Department of Health), DM-related deaths, and
pre-diabetes-related deaths were adjusted for each relevant age group category, namely
from age range 45–54 years to 55–64 years, and finally to 65–74 years.

The healthcare costs in the Base Scenario were derived from the cost of an average patient
with one or more complications and the costs for a diabetic patient without complications.
The risk of complications for patients with DM is dependent on the years of DM history. Both
cost values were derived from previously published literature on DM patients in Hong Kong
(Jiao et al., 2017, 2018).

Scenario 1

The model differs in demographic changes in Base Scenario by additionally introducing a
flow parameter showcasing remission from DM toward pre-DM. As a point of convergence
from the Base Scenario, the incidence of new DM cases progressing from pre-diabetes
cases was lowered to reflect the implementation of an intervention protocol. Mortality rates
were kept consistent between Base Scenario and Scenario 1.

The healthcare costs in Scenario 1 were based on a similar methodology to the Base
Scenario. Additional expenditures to the healthcare costs in Scenario 1 include the cost of
screening and cost of basic intervention for individuals diagnosed with DM. Based on
guidance from the Hong Kong Reference Framework for Diabetes, only individuals diagnosed
with pre-diabetes and who are deemed “high-risk”, defined as those who do not engage in
vigorous or moderate physical exercise, require annual rescreening for DM after the first year.

Within the model and Scheme framework, all individuals diagnosed with DM will receive an
annual subsidy of HKD 3,486, equivalent to the cost of an annual General Outpatient
Clinic-Public-Private Partnership (GOPC-PPP) subsidy in 2021, to access additional
healthcare services for DM management. Such services extend beyond basic follow-up care,
such as medication, consultations, and screenings for complications, and are geared
towards empowering facilitating improved health (such as visits with dietitians, allied health
professionals, physical trainers, etc.).

Using the healthcare costs calculations, we also determined the cost to prevent one mortality
based on projections of the number of mortalities that would result in Scenario 1. This
calculation will help to elicit the cost-effectiveness of the proposed Scheme.

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