COST-EFFECTIVENESS ANALYSIS OF DEPREXIS, A PRESCRIBED DIGITAL THERAPEUTIC INTERVENTION FOR UNTREATED ADULTS WITH MAJOR DEPRESSIVE DISORDER IN SOUTH AFRICA
Author(s)
Aayushi Prashant Patel, MSc1, Richard Ssegonja, PhD2, Filipa Sampaio, PhD2.
1Karolinska Institutet, Stockholm, Sweden, 2Department of Public Health and Caring Sciences; Uppsala Health Economics (UHE), Uppsala University, Uppsala, Sweden.
1Karolinska Institutet, Stockholm, Sweden, 2Department of Public Health and Caring Sciences; Uppsala Health Economics (UHE), Uppsala University, Uppsala, Sweden.
OBJECTIVES: Over 75% of adults with major depressive disorder in South Africa remain untreated due to workforce shortages and access barriers. This leaves most patients without standard care. Prescribed digital therapeutics (PDTx) offer a scalable option, but no economic evidence exists in this setting. This study estimated the cost-effectiveness of Deprexis, a PDTx, for untreated adults (18-65 years) with major depressive disorder (MDD) in South Africa, from a healthcare payer perspective.
METHODS: A Markov cohort model simulated depression progression over a 5-year horizon. Clinical effectiveness and health utility inputs were obtained from published literature, and cost inputs were adapted to the South African context. Costs and outcomes were discounted at 5% annually and reported in 2025 USD with conversions based on purchasing power parity (PPP). Deterministic and probabilistic sensitivity analyses, scenario analyses, a price threshold analysis, a return-on-investment (ROI) analysis, and a 5-year budget impact analysis were conducted. Cost-effectiveness was assessed against a willingness-to-pay threshold of USD PPP 5,118 per quality-adjusted life-year (QALY).
RESULTS: Deprexis was dominant, generating 0.18 additional QALYs while reducing costs by USD 419 per person over 5 years. ROI was 1.97, with a 99% probability of cost-effectiveness at the willingness-to-pay threshold. Results were most sensitive to the intervention effect and cost, though no plausible variation reversed the conclusion. The price threshold analysis indicated cost-effectiveness held up to a 4.3-fold increase above the current subscription price. Cumulative net budget impact was USD 9.86 million over 5 years, with annual net costs becoming cost-saving in Year 5.
CONCLUSIONS: Deprexis is potentially cost-effective for adults with MDD in South Africa, with findings robust to parameter uncertainty. These results provide the first economic evidence to inform reimbursement and adoption discussions for PDTx within the public sector, while underscoring the need for local implementation and effectiveness studies to confirm real-world impact.
METHODS: A Markov cohort model simulated depression progression over a 5-year horizon. Clinical effectiveness and health utility inputs were obtained from published literature, and cost inputs were adapted to the South African context. Costs and outcomes were discounted at 5% annually and reported in 2025 USD with conversions based on purchasing power parity (PPP). Deterministic and probabilistic sensitivity analyses, scenario analyses, a price threshold analysis, a return-on-investment (ROI) analysis, and a 5-year budget impact analysis were conducted. Cost-effectiveness was assessed against a willingness-to-pay threshold of USD PPP 5,118 per quality-adjusted life-year (QALY).
RESULTS: Deprexis was dominant, generating 0.18 additional QALYs while reducing costs by USD 419 per person over 5 years. ROI was 1.97, with a 99% probability of cost-effectiveness at the willingness-to-pay threshold. Results were most sensitive to the intervention effect and cost, though no plausible variation reversed the conclusion. The price threshold analysis indicated cost-effectiveness held up to a 4.3-fold increase above the current subscription price. Cumulative net budget impact was USD 9.86 million over 5 years, with annual net costs becoming cost-saving in Year 5.
CONCLUSIONS: Deprexis is potentially cost-effective for adults with MDD in South Africa, with findings robust to parameter uncertainty. These results provide the first economic evidence to inform reimbursement and adoption discussions for PDTx within the public sector, while underscoring the need for local implementation and effectiveness studies to confirm real-world impact.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE495
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Disease
Mental Health (including addiction), No Additional Disease & Conditions/Specialized Treatment Areas