Value-for-money for Innovative Medicine

Fact Sheet

Current and Forecasted Depression Burden

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Treatment-Resistant Depression (TRD)

Definition of innovative medicine

The candidate list of innovative medicines in the Hong Kong setting was generated from horizon scanning conducted up to 31 December 2024. Only those medicines with Phase III trial evidence were considered eligible for inclusion and were subsequently included in this analysis.

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

The cost-effectiveness frontier included AUG, COM, cPSY, ESK, and ECT. This indicates that these strategies were non-dominated options in the incremental cost-effectiveness analysis. Compared with AUG, ESK had an ICER of HK$1,825,149 per QALY. This exceeded the WTP threshold of three times GDP per capita in Hong Kong (HK$1,265,970 per QALY).

Note:

Each point represents a treatment strategy for TRD compared with augmentation therapy.
The solid line represents the efficiency frontier formed by non-dominated strategies, indicating the set of potentially cost-effective options across different WTP thresholds.
The two dashed reference lines indicate the WTP thresholds corresponding to 1× and 3× GDP per capita in Hong Kong in 2024 (HK$421,990 and HK$1,265,970 per QALY, respectively).

Figure: Cost-effectiveness acceptability curves for treatment-resistant depression strategies.

The cost-effectiveness acceptability curves summarise uncertainty in cost-effectiveness across different WTP thresholds. At the threshold of three times GDP per capita in Hong Kong, HK$1,265,970 per QALY, ESK had a 19.3% probability of being the most cost-effective strategy, while COM remained the preferred option. At a higher WTP threshold of HK$1,643,347 per QALY, ESK became the most likely cost-effective option.

Note:

The two dashed reference lines indicate the WTP thresholds corresponding to 1× and 3× GDP per capita in Hong Kong in 2024 (HK$421,990 and HK$1,265,970 per QALY, respectively).

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; GDP, gross domestic product; QALY, quality-adjusted life year; WTP, willingness-to-pay.

Table: Estimated budget impact of TRD treatment strategies (million HK$, Hong Kong healthcare payer perspective).

The target population comprised patients with treatment-resistant depression (TRD) in Hong Kong, identified from the territory-wide electronic medical database managed by Hong Kong Hospital Authority. At model entry in 2024, the baseline prevalent population was 7,678 patients. The annual incident cohorts entering the budget impact model in 2025–2029 were projected to be 578, 969, 1,228, 1,238, and 1,247, respectively.

Two market share scenarios were assessed to illustrate a range of possible uptake for each treatment strategy among patients in the treatment pathway.

Scenario 1 (100% uptake per strategy): all entering patients were assigned to the evaluated treatment strategy from Year 1 onward.
Scenario 2 (equal market share): entering patients were allocated according to an equal market share from Year 1 onward. For TRD, this corresponded to 14.3% per strategy across seven treatment options.

Abbreviations: TRD, treatment-resistant depression; 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.