1. The Use of Pharmacoeconomics in the Process of Updating the National List of Health Services in Israel Dan Greenberg, Ph.D. 1,2 1. 1. Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel 2. 2. ISPOR-Israel ISPOR Eastern and Central European Forum Dublin, October 23, 2007

2. The Israeli Healthcare System A semi-public system, dominated by the Ministry of Health (and the Ministry of Finance) and the countrys four health plans (HMOs) The National Health Insurance Law (NHIL) enacted in 1995 has made health insurance both compulsory and universal The NHIL stipulates a National List of Health Services (NLHS) which all residents are entitled from their health plans

3. The Process of Updating the NLHS Call for proposals for new technologies to be included in the NLHS Call for proposals for new technologies to be included in the NLHS Submission of dossiers according to guidelines published by the Ministry of Health Submission of dossiers according to guidelines published by the Ministry of Health Rapid screening and assessment of proposed technologies Rapid screening and assessment of proposed technologies

4. The Process of Updating the NLHS Comprehensive evaluation and ranking of technologies Comprehensive evaluation and ranking of technologies Discussions and recommendations made by the Public National Advisory Committee Discussions and recommendations made by the Public National Advisory Committee Government approval, legislation and allocation of funds to health plans Government approval, legislation and allocation of funds to health plans

5. The Process of Updating the NLHS

6. The ultimate objective of the committee (process) is to inform decision-makers on new technologies which will both maximize health outcomes and provide good value for money under a pre-specified budget constraint

7. The Process of Updating the NLHS Absolute priority is given to "life saving" technologies with total disregard of preventive services The use of pharmacoeconomics (cost- effectiveness and budget impact analyses) is essential

8. The Use of Pharmacoeconomics Timing of adoption: Israel is an early adopter of life-saving technologies. Adoption decisions are made prior the availability of economic data The large number of technologies considered does not allow a comprehensive health technology assessment Transferability of cost-effectiveness models cannot be easily adapted to the Israeli healthcare setting

9. The Use of Pharmacoeconomics Lack of good local data: epidemiological and economic data are not always available The Ministry of Health has insufficient personnel to conduct economic evaluations Only budget impact analyses are used to guide coverage decisions

10. What can be done? Encourage collaborations between HMOs, Ministry of Health and Pharmaceutical companies Consider Rapid technology assessments to guide decisions Collaboration with agencies in other countries