Value-for-money for Innovative Medicine

Fact Sheet

Current and Forecasted Depression Burden

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Treatment-Resistant Depression (TRD)

Figure: Cost-effectiveness efficiency frontier of treatment-resistant depression strategies.

On the cost-effectiveness plane, esketamine is more cost-effective than rTMS and ECT, both of which lie well above three times GDP per capita threshold.

Esketamine sits on the efficiency frontier, suggesting relatively better value and lower cost compared with rTMS.

Note: Abbreviations: AUG: Augmentation therapy (antidepressant combined with antipsychotic/lithium); COM: Combination therapy (antidepressant combined with antidepressant); mPSY: Psychotherapy alone; cPSY: Psychotherapy combined with antidepressant; ESK: Esketamine combined with antidepressant; rTMS: Repetitive transcranial magnetic stimulation combined with antidepressant; ECT: Electroconvulsive therapy combined with antidepressant; QALY, Quality-Adjusted Life Year; GDP, Gross Domestic Product.

Each point represents a third-line treatment strategy for TRD compared with augmentation therapy. The solid grey line represents the efficiency frontier formed by non-dominated strategies, indicating that these strategies may be cost-effective at different WTP thresholds. Grey dashed lines denote indifference curves, which reflect equal cost-effectiveness ratios under the specified WTP thresholds.

Figure: Cost-effectiveness acceptability curves (CEACs) illustrating the probability of each treatment strategy as most cost-effective across varying WTP thresholds, based on 10,000 Monte Carlo simulations.

The CEACs summarise this uncertainty across different WTP thresholds.

At three-time GDP per capita threshold, esketamine has roughly a 19.3% probability of being the most cost-effective option.

At a higher threshold (WTP value = HK$ 1,643,347/QALY), the esketamine first becomes the most cost-effective option.

Abbreviations: AUG: Augmentation therapy (antidepressant combined with antipsychotic/lithium); COM: Combination therapy (antidepressant combined with antidepressant); mPSY: Psychotherapy alone; cPSY: Psychotherapy combined with antidepressant; ESK: Esketamine combined with antidepressant; rTMS: Repetitive transcranial magnetic stimulation combined with antidepressant; ECT: Electroconvulsive therapy combined with antidepressant. QALY, Quality-Adjusted Life Year; GDP, Gross Domestic Product; WTP, willingness-to-pay.Abbreviations: AUG: Augmentation therapy (antidepressant combined with antipsychotic/lithium); COM: Combination therapy (antidepressant combined with antidepressant); mPSY: Psychotherapy alone; cPSY: Psychotherapy combined with antidepressant; ESK: Esketamine combined with antidepressant; rTMS: Repetitive transcranial magnetic stimulation combined with antidepressant; ECT: Electroconvulsive therapy combined with antidepressant. QALY, Quality-Adjusted Life Year; GDP, Gross Domestic Product; WTP, willingness-to-pay.

Table: Esketamine Estimated Budget Impact (HK$, Hong Kong Healthcare Payer Perspective):

Two distinct market share scenarios were assessed to illustrate a range of possible uptake for esketamine among newly entering patients in the TRD treatment pathway:

Scenario 1: Full market share (100%): All newly entering patients in the TRD treatment pathway receive esketamine from Year 1 onward.
Scenario 2: Conservative market share (14.3%): Esketamine is assigned to 14.3% of newly entering patients in the TRD treatment pathway from Year 1 onward, assuming equal distribution across the seven third-line treatment options.

Assuming a baseline prevalent TRD population of 7,678 in 2024 at model entry, the annual incident TRD cohorts entering the budget impact model were estimated to be approximately 578 in 2025, 969 in 2026, 1228 in 2027, 1238 in 2028, and 1247 in 2029.

Note: Abbreviations: AUG: Augmentation therapy (antidepressant combined with antipsychotic/lithium); COM: Combination therapy (antidepressant combined with antidepressant); mPSY: Psychotherapy alone; cPSY: Psychotherapy combined with antidepressant; ESK: Esketamine combined with antidepressant; rTMS: Repetitive transcranial magnetic stimulation combined with antidepressant; ECT: Electroconvulsive therapy combined with antidepressant.