Hong Kong modeling study shows policy bundles could cut esketamine costs for TRD while preserving health gains

{"The HKUMed-led team modeled esketamine nasal spray against six established third-line regimens for treatment-resistant depression, incorporating local cost, utilization, and outcome data. Price negotiation, value-based contracts, streamlined clinic protocols, and stricter patient selection each improved the incremental cost-effectiveness ratio; combined they brought the ratio below common willingness-to-pay thresholds used in publicly funded systems.","Esketamine outperformed psychotherapy alone, augmentation, and rTMS on QALYs but remained more expensive than ECT in some scenarios. The analysis highlights that supervised-administration requirements and drug price dominate total costs, explaining why service redesign and contracting strategies yield larger efficiency gains than clinical tweaks alone.","Global parallels include England’s NICE re-appraisal and Australia’s risk-sharing agreements for esketamine, both of which tied reimbursement to real-world response rates. Hong Kong’s public system faces similar capacity constraints; without targeted policies, rapid uptake could crowd out rTMS slots or increase specialist wait times.","Next steps require prospective collection of local response and relapse data to replace model inputs, plus pilot implementation of negotiated pricing to test whether projected savings materialize within two budget cycles."}