Economic Evaluation of a Screening Programme for Diabetes, Hypertension and Hyperlipidaemia in Middle-Aged Adults in Hong Kong: A Simulation Analysis

OBJECTIVES: The American Diabetes Association recommends screening for Type 2 diabetes and prediabetes in earlier age of 45 and above. This study evaluated the cost-effectiveness of a screening program for diabetes mellitus, hypertension and hyperlipidemia among middle-aged adults aged 45-64 in the local context of Hong Kong.

METHODS: A simulation study of implementing a screening program for the three selected diseases was conducted among 2.2 billion adults aged 45-64 without a historical diagnosis of diabetes in Hong Kong. A validated state-transition Markov Monte Carlo simulation model named CDC-RTI Diabetes Cost-Effectiveness Model was used to simulate the disease progression of diabetes, hypertension and hyperlipidemia. Key parameters on population demographics, disease progression, costs of screening and treatment, and health outcomes were derived from Census Statistics and local published literatures. Analytical perspective was public health care system. Health outcomes of interest were newly detected cases, life year and quality-adjusted life year gained (QALYs), occurrence of disease-related complications and death due to complications. Incremental cost-effectiveness ratios (ICERs) for different outcomes were also calculated.

RESULTS: Compared to no screening, one-off screening could detect a total of 54,529 new cases with diabetes in Hong Kong in the year 2020. The number of tests required and average cost to detect a new diabetes case was estimated at 40 and US$3,939, respectively. Implementation of the screening program could increase total healthcare costs by US$0.79 billion, including US$0.22 billion screening cost and US$0.77 billion extra cost due to earlier treatment. Inversely, early screening could bring a cost-saving of US$0.18 billion by preventing disease-related complications. The ICERs of the screening program were estimated at US$5,523 and US$11,633 for each life year and each QALY gained.

CONCLUSIONS: A early screening program for diabetes mellitus, hypertension and lipid disorders among general middle-aged adults was acceptable and recommended in both health and economic aspects in Hong Kong.