LCQ18: Treating depression by Transcranial Magnetic Stimulation
3.5.2023

Following is a question by the Hon Lam So-wai and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (May 3): Question: It has been reported that the efficacy of Transcranial Magnetic Stimulation (TMS) in treating treatment-resistant depression was recognised by the Food and Drug Administration in the United States in 2013. Subsequently, governments around the world have studied and implemented the therapy one after another, and various hospital clusters under the Hospital Authority (HA) have also been equipped with relevant devices in recent years. However, it is learnt that first-generation TMS devices which demonstrate unsatisfactory precision performance are still in use within HA. In this connection, will the Government inform this Council: (1) whether it knows the number of depression patients receiving treatment from HA over the past five years and the average waiting time taken by such patients to receive treatment; (2) whether it knows the major treatment methods currently provided by HA to patients suffering from treatment-resistant depression; (3) whether it knows the hospitals under HA where TMS is currently available, and when such therapy was first made available in those hospitals; the maximum number of patients those hospitals can treat using TMS each year and the number of patients who have received such treatment; (4) whether it knows the training situation of HA doctors in relation to the clinical application of Repetitive Transcranial Magnetic Stimulation (rTMS); what measures HA has currently in place to enhance patients' understanding of such therapy; (5) whether it will in future introduce TMS fully to the public healthcare system in Hong Kong and install for hospitals the latest generation of TMS devices which are equipped with neuronavigation functions, with a view to providing patients suffering from treatment-resistant depression with personalised and precise treatment; and (6) whether the Government will conduct studies on ways to encourage the insurance trade to increase the coverage limits for psychiatric treatment (e.g. rTMS) with a view to alleviating HA's long-term financial burden and benefiting more patients? Reply: President, In consultation with the Hospital Authority (HA), the reply to the questions raised by the Hon Lam So-wai is as follows: (1) The table below sets out the number of psychiatric patients diagnosed with depression/ depressive disorders and received treatment in the HA from 2018-19 to 2022-23. Year Number of psychiatric patients diagnosed with depression / depressive disorders and received treatment in the HA 2018-19 56 100 2019-20 58 800 2020-21 61 300 2021-22 64 700 2022-23 (Projection as of December 31, 2022) 66 000 Note: 1. Including in-patients, patients at specialist out-patient clinics and day hospitals. 2. Figures are rounded to the nearest hundred. The table below sets out the number of psychiatric specialist out-patient (SOP) new cases in the HA triaged as Priority 1 (urgent), Priority 2 (semi-urgent) and Routine (stable) cases and their respective median waiting time from 2018-19 to 2022-23. The HA does not maintain statistics on the breakdown of median waiting time for patients with depression / depressive disorders. Year Priority 1 Priority 2 Routine Number of new cases Median waiting time (weeks) Number of new cases Median waiting time (weeks) Number of new cases Median waiting time (weeks) 2018-19 2 694 1 8 859 4 34 684 30 2019-20 2 761 1 8 523 3 31 978 27 2020-21 3 377 1 10 637 3 33 411 27 2021-22 2 928 1 9 995 4 37 025 40 2022-23 (provisional figures) 2 563 1 10 096 4 38 608 40 Note: 1. With effect from October 1, 2022, the waiting time for new case booking at SOP clinics has incorporated that at integrated clinics. Remark: In view of the emergence of the Coronavirus Disease 2019 epidemic in Hong Kong since early 2020, the HA has adjusted its services in response to the epidemic. This should be taken into account when comparing the throughput of services provided by the HA across the years. (2) to (5) The HA's psychiatric multidisciplinary team involving doctors, nurses, clinical psychologists, occupational therapists, medical social workers, etc., has been delivering comprehensive and continuous medical services, including in-patient, out-patient, day rehabilitation training and community support services, to patients with mental health problems (including patients with depression / depressive disorders), depending on the severity of their conditions and their clinical needs. Transcranial Magnetic Stimulation (TMS) therapy has been introduced by phases to psychiatric services of the HA in all clusters since 2016-17. Psychiatric healthcare professionals in HA hospitals will refer suitable patients with depression / depressive disorders to receive TMS therapy according to their medical conditions and clinical needs. At present, TMS equipment is available in each cluster for treating psychiatric patients with depression / depressive disorders as follows: Cluster Hospital Hong Kong East Pamela Youde Nethersole Eastern Hospital Hong Kong West Queen Mary Hospital Kowloon Central Kowloon Hospital Kowloon East United Christian Hospital Kowloon West Kwai Chung Hospital New Territories East Tai Po Hospital New Territories West Castle Peak Hospital The HA does not maintain statistics on the number of patients who have undergone TMS therapy. To strengthen the understanding of TMS therapy by healthcare professionals, the HA earlier invited overseas experts to conduct centrally commissioned training on TMS (including theoretical lectures and practical training) so that healthcare professionals could learn and exchange relevant knowledge and clinical practice for referring suitable patients for relevant treatment according to the latter's needs. In addition, when hospitals purchase TMS equipment, the supplier will also provide theoretical and practical training for relevant healthcare professionals. For patients, healthcare professionals will generally brief the patient/family on relevant information (including brief introduction, procedures, risks, complications of the treatment) before the patient consents to receive TMS therapy. Relevant information leaflet will also be provided to the patient/family to enhance their understanding of TMS therapy. The HA has all along attached great importance to the modernisation and enhancement of medical equipment while continuously upgrading equipment so as to enhance service quality for patients. Development of modern healthcare services focuses on application of technology. Advancement in medical technology facilitates more expeditious and accurate diagnosis, and can improve quality of patient care. Novel medical techniques also make possible new treatment methods that are less invasive or more precise, which is in turn conducive to better clinical outcomes that directly benefit patients. The HA will keep abreast of the medical technology development and has in place an established mechanism where experts study and evaluate treatment options for patients as well as the latest development of clinical and scientific evidence of relevant technology in a timely manner. Scientific evidence, cost-effectiveness, risks (e.g. medical technology risk, safety and compliance status of equipment, safety of patients/ staff), opportunity costs, technological advancement and opinions from patient groups, etc will be taken into account in the process. Moreover, the HA will consider the availability of expertise, manpower and facilities as well as the advice from healthcare professionals and overseas experts in planning for medical technology development. (6) Having taken into account factors such as premium level, market competition and consumer protection, the Government has included the coverage of psychiatric treatments under the Voluntary Health Insurance Scheme (VHIS). At present, all VHIS certified plans must cover psychiatric treatments during confinement in hospitals in Hong Kong. The benefit limit of Standard Plans is $30,000 per policy year, and higher benefit amounts may be offered by Flexi Plans. Insured persons can apply for claims with the insurers according to the policy terms of the relevant products.