Cost-effectiveness Analysis of Patient Empowerment Programme on Diabetes Mellitus

Abstract

Introduction and project objectives: The Hospital Authority has introduced a Patient Empowerment Programme (PEP) for Diabetes Mellitus (DM) patients in 2010 to enhance their disease-specific knowledge and self-management skills, and thus their self-efficacy and lifestyle modifications. The aim of this study was to evaluate the cost-effectiveness of PEP among DM patients who had also enrolled to the Risk Assessment and Management Programme (RAMP-DM) by modelling cost-effectiveness over the five years and programme expansion to identify cost-drivers and areas of uncertainty. Methods: A cohort study was conducted with primary outcomes being the first occurrence of a macrovascular or microvascular complication or mortality of any cause during the follow-up period in the PEP and non-PEP groups. The programme costs were estimated from the societal perspective which included the provider’s costs of setting up and running PEP, the costs to the community, and the costs to the subjects attending PEP. These data were incorporated into an individual-based Markov state-transition model to simulate lifetime costs and outcomes for DM patients with or without PEP. Incremental cost-effectiveness ratio (ICER) was calculated as cost per quality-adjusted life years (QALY) gained, assuming a 5-year programme effect with future cost and QALY discounted at 3.5% per year. Probabilistic sensitivity analysis was conducted with results presented as a cost-effectiveness acceptability curve. Results: There was a significantly lower cumulative incidence of all deaths (2.9% vs 4.6%, p<0.001); any DM complications (9.5% vs 10.8%, p=0.001); and cardiovascular disease events (6.8% vs 7.6%, p=0.018) in the PEP group than those in the non-PEP group. The programme cost was a 1-time cost and the societal cost per subject for PEP was HK$1,929. In the long term model, the ICER was HK$23,358 per QALY gained at 2013 cost and was highly cost-effective when compared to a willingness-to-pay threshold of HK$240,000 per QALY. Probabilistic sensitivity analysis showed that PEP was 65% likelihood to be costeffective compared with non-PEP when willingness-to-pay for a QALY was HK$200,000 or above. Conclusion: The extra amount allocated for running PEP was just under HK$2,000 and appeared to be compensated for to a large extent by improved health of the subjects. Given the carefully measured cost of PEP and the potential benefits in addition to RAMP-DM, we found PEP could be highly cost-effective.