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Scenario analysis 7: Varying uptake rates of Scheme participation

The original model was designed with the assumption that all individuals in the target
population of Hong Kong individuals aged 45–54 years will equally participate in the
intervention in question. Thus, the original Base Scenario suggests that no population-wide
screening or management programme is available and thus, the full target population is
assumed to not partake in screening or more intensive management. Conversely, the original
Scenario 2 suggests that all individuals in the target population partake in both screening
and the recommended RAMP-DM programme. However, data from existing PPPs suggest
that when new interventions are implemented, there is a gradual uptake of the intervention
rather than full participation within the first year of implementation.

To model this gradual uptake of the proposed Scheme in Scenario 2, we used the ever-use
rates from the first ten years of the Elderly Health Care Voucher Scheme (EHCVS), adjusting
for the shift in eligibility and assuming that the participation rate plateaus after the initial ten
years of Scheme implementation (FHB, 2019).

Table 14
Shifts in savings and mortality after varying uptake rate of Scheme

Scenario 2 (All in) Varying Uptake
Costs over 30 years HKD 32,845.33 HKD 32,267.43
Costs and Savings over 30 years HKD 12,501.43 HKD 13,079.33
Savings
% Savings 27.57% 28.84%
Mortality–DM 13,757 19,862
Mortality–PreDM 22,133 21,140
Mortality
Total Prevented Mortality 47,138 42,026
Cost to prevent one HKD 696,794.93 HKD 767,798.33
mortality

We find that when we model the participation in the Scheme off the ever-use rates of the
EHCVS, our cost-savings marginally surpasses the cost-savings of full participation in
Scenario 2 though the total prevented mortality is lower, thus causing a higher cost to
prevent one mortality. Despite the relatively higher direct costs of implementation, these
figures do not yet account for the indirect benefits to the health system or to patients. This
finding showcases the necessity of promoting the Scheme for higher uptake in the initial
years in order to reduce the number of preventable mortalities moving forward.

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