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Table 10
Changes in percent of cost-savings in Scenario 2 due to complication
rates and costs of complications per patient

Complication rates
2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% 10.0%
20,000 40.2% 40.0% 39.7% 39.5% 39.3% 39.0% 38.8% 38.6% 38.3%
32.1%
38.1%
40,000 38.9% 36.2% 37.2% 36.4% 35.5% 34.7% 33.8% 33.0% 26.0%
Cost per patient with one or more complications (HKD) 80,000 36.5% 34.4% 32.3% 30.2% 28.1% 26.0% 23.9% 21.8% 19.8%
34.8%
37.7%
27.4%
33.3%
31.8%
30.4%
28.9%
60,000
100,000
32.5%
35.2%
13.6%
27.1%
19.0%
24.4%
21.7%
29.8%
16.3%
17.4%
7.4%
10.7%
14.0%
24.0%
27.3%
30.7%
20.7%
120,000
34.0%
9.1%
24.9%
32.8%
5.1%
28.8%
140,000
1.2%
13.0%
20.9%
17.0%
4.1%
-5.0%
160,000
30.3%
4.4%
19.9%
14.7%
9.5%
-6.0%
25.1%
180,000 31.5% 27.0% 22.4% 17.8% 13.3% 8.7% -0.8% -0.4% -11.2%
200,000 29.0% 23.2% 17.4% 11.6% 5.8% 0.0% -5.8% -11.6% -17.4%
Using our projected cost-savings percentage for Scenario 2 as our base (marked brown
borders), we then assessed combinations of rates and costs that would lead to higher cost-
savings percentages (highlighted in green), combinations that would result in percentages
between 27.0% and 28.0% that match our current projections (highlighted in yellow),
combinations that would result in lower percentages (no highlights), and combinations that
would result in net-zero or negative benefits (highlighted in red). Under our current model
mechanics, we found that many combinations of complication rates and costs may still lead
to higher cost-savings percentages, with costs per patients of HKD 60,000 or lower per year
leading to higher cost-savings up to complication rates of 9.0%. Additionally, we find that the
health system is projected to reach a net-zero cost-savings if the rate for complication
development reaches 7.0%, with a cost per patient with complications of HKD 200,000, both
of which far surpass the figures proposed in research. These figures are promising to the
health system, as they suggest that the implementation of screening and management for
diabetes is likely to be beneficial in direct budgetary terms, even when excluding indirect
benefits to patients.
Scenario analysis 4: RAMP-DM costs
Within the current model mechanics, the cost of implementing the management Scheme on
a population-wide basis is derived from the five-year cost effectiveness study of RAMP-DM,
using an annual cost of HKD 244.92 per patient, regardless of age and level of risk (F. F. Jiao
et al., 2018). Understandably, while this cost per patient may be reasonable when
implemented with a smaller subset of the population with diabetes, an annual spending of
less than HKD 300 may not be sufficient when factoring in the additional costs, for example
due to implementation in the private sector, such as additional staffing, technology, and
administrative costs. To assess the cost impact of a higher cost of implementation in the
private sector, we conducted scenario analyses using annual costs of HKD 500, HKD 1,000,
and HKD 1,500. We observe that the cost-savings in Scenario 2 decrease as the cost of
RAMP-DM implementation increases. Nonetheless, even at a RAMP-DM implementation
cost of HKD 1,500 per patient per year, the cost-savings percentage remains above 20%
relative to the Base Scenario (Table 11).
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