Amir Shmueli1. 1. The Hebrew University and the Gertner Institute, Jerusalem, Israel.
Abstract
OBJECTIVE: The Public Committee (PC), which decides on the inclusion and ranking of new technologies in the Israeli List of Health Services facing a given budget, does not explicitly consider the results of economic evaluations of the technologies discussed. The present article includes an ex post economic examination of the PC's 2006/2007 decisions. METHODS: The cost per quality-adjusted life-year (QALY) (CPQ) values of the technologies approved and rejected were retrieved from national health technologies assessments and the professional literature. RESULTS: CPQ values were found for 40 technologies out of the 52 that were approved by the PC, and for 26 out of 42 randomly sampled among those rejected. The technologies approved for inclusion produce QALYs in a cheaper way, in general, than those rejected. A CPQ of about 50,000 new Israeli shekels (NIS) (15,500 USDPPP [purchasing power parity adjusted U.S. dollars]) is identified as the best discriminating value between approved and rejected technologies. The agreement between the PC's ranking of the approved technologies and the ranking by CPQ is low, and the only significant determinant of the Committee's ranking is the number of patients expected to benefit from the technology. CONCLUSIONS: Although not considering CPQ data explicitly, the PC tends, in fact, to approve technologies with relatively low CPQ. In ranking the approved technologies, however, the PC tries to maximize the number of persons expected to benefit from the additional budget even at the expense of possibly giving up cheaper QALYs. The size of the budget should be determined in accordance with an Israeli value of QALY and Israeli values of the CPQ of the technologies submitted for inclusion.
OBJECTIVE: The Public Committee (PC), which decides on the inclusion and ranking of new technologies in the Israeli List of Health Services facing a given budget, does not explicitly consider the results of economic evaluations of the technologies discussed. The present article includes an ex post economic examination of the PC's 2006/2007 decisions. METHODS: The cost per quality-adjusted life-year (QALY) (CPQ) values of the technologies approved and rejected were retrieved from national health technologies assessments and the professional literature. RESULTS:CPQ values were found for 40 technologies out of the 52 that were approved by the PC, and for 26 out of 42 randomly sampled among those rejected. The technologies approved for inclusion produce QALYs in a cheaper way, in general, than those rejected. A CPQ of about 50,000 new Israeli shekels (NIS) (15,500 USDPPP [purchasing power parity adjusted U.S. dollars]) is identified as the best discriminating value between approved and rejected technologies. The agreement between the PC's ranking of the approved technologies and the ranking by CPQ is low, and the only significant determinant of the Committee's ranking is the number of patients expected to benefit from the technology. CONCLUSIONS: Although not considering CPQ data explicitly, the PC tends, in fact, to approve technologies with relatively low CPQ. In ranking the approved technologies, however, the PC tries to maximize the number of persons expected to benefit from the additional budget even at the expense of possibly giving up cheaper QALYs. The size of the budget should be determined in accordance with an Israeli value of QALY and Israeli values of the CPQ of the technologies submitted for inclusion.