PHP59 THE AVAILABILITY AND SIGNIFICANCE OF COST-EFFECTIVENESS DATA FOR INFORMING DECISIONS TO ADD NEW DRUGS TO THE NATIONAL LIST OF HEALTH SERVICES IN ISRAEL

OBJECTIVES: The National List of Health Services (NLHS) in Israel has been updated annually since 1999 but results from economic evaluations (EE) were not used to support coverage decisions. We explored the potential availability of EE results to the committee responsible for updating the NLHS at the times of coverage decisions and whether availability and use of these data could have altered these decisions. METHODS: We used the Tufts Medical Center Cost-Effectiveness Analysis Registry (http://www.cearegistry.org) to search for relevant cost/QALY EE for all drugs and their relevant indications added to the NLHS from 1999 through 2008. For each pair of drug and cost/QALY publication we recorded the publication date, the intervention(s) and comparator(s) considered and the incremental cost-effectiveness ratio (ICER) to determine value for money. Based on available ICERs we qualitatively classified each coverage decision into one of three categories: 1)The coverage decision can be justified on EE grounds (EE suggest the drug is either dominant/cost-saving or provides good value for money); 2)The coverage decision cannot be justified on EE grounds; 3)The evidence from EE is mixed and we could not determine whether the coverage decision can be justified or not. RESULTS:
Relevant cost/QALY analyses were found for 181(40%) of 451 drugs included in the updates of the NLHS of which only 71 (16%) of drugs had relevant EE prior to the coverage decision. Based on the evidence gathered from EE prior to and following the coverage decision, we suggest that decisions were correct in 56% of the cases, incorrect in 17% and ambiguous in 27%. CONCLUSIONS: The use of EE to support coverage decisions could have altered decisions in a sizable proportion of drugs added to the NLHS in Israel. Avoiding the use of results from EE to support public funding of drugs may lead to a non-optimal use of scarce healthcare resources.