Is Risk-Assessment-and-Management-Programme for primary care patients with Hypertension (RAMP-HT) cost-effective?

Abstract

INTRODUCTION The multi-disciplinary Risk-Assessment-and-Management-Programme for patients with hypertension (RAMP-HT) integrated into usual care was effective in improving blood pressure (BP) control and reducing 10-year predicted cardiovascular disease (CVD) risk of primary care hypertensive (HT) patients after 12 months. This study aimed to assess the long-term cost-effectiveness of the RAMP-HT after 5 years. METHODS A territory-wide prospective cohort was conducted on 58,514 RAMP-HT participants matched by propensity score with the same number of HT patients managed by General-Out-Patient-Clinics (GOPC) between October 2011 and September 2013. All subjects were aged ≥18years without previous clinical diagnosis of CVD or end-stage renal disease (ESRD). RAMP-HT costs included set-up cost, administrative cost, and the number of RAMP-HT interventions used multiplied by unit cost. RAMP-HT effectiveness was estimated by 5-year cumulative incidence of developing complications and all-cause mortality. RAMP-HT cost-effectiveness was reflected by Incremental-Cost-Effectiveness Ratio (ICER) and program costs per event prevented. RESULTS RAMP-HT significantly reduced incidences of CVD (9.0% vs 14.1%, p<0.001), ESRD (1.3% vs 2.3%, p<0.001) and all-cause mortality (5.3% vs 10.9%, p<0.001), compared to usual care. The 5-year average RAMP-HT cost was US$63 per participant. The RAMP-HT costed US$1,242, US$6,732 and US$1,333 to reduce one CVD, ESRD and death over 5 years, respectively. DISCUSSION The encouraging results confirmed that RAMP-HT was cost-effective in preventing HT-related complications and mortality up to 5 years. Further study should be conducted to evaluate the lifetime cost-effectiveness of the RAMP-HT to confirm the sustainability of RAMP-HT and its actual impact on healthcare services and resources.