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Computer may prioritize certain health basket drugs

New software developed in New Zealand and improved in Israel for choosing medications for the health basket.

Computer may prioritize certain health basket drugs
Photograph by Árpád Czapp

Haaretz, 30 September 2009

by Dan Evan

New software developed in New Zealand and improved in Israel may be used in choosing medications for the health basket, Haaretz had learned. The software allows the selection of medications according to pre-set criteria.

It was introduced to the committee that determines which drugs make it into the health basket by the program's developer, Dr. Paul Hansen from the University of Otago. The Israeli version of the software was presented at the December 2008 conference of the Israel National Institute for Health Policy and Health Services Research by Dr. Orna Tal, head of the Health Ministry's Technology Policy Division. The software had been customized over the preceding year by Dr. Ofra Golan of the genetics and bioethics unit at the Gertner Institute for Epidemiology and Healthcare Research.

Among the new criteria installed in the software are the safety and effectiveness of a given medication, the need for the medication, the size of the target patient group, the availability of alternative treatments and the medication's cost. At the end of the process, the medications proposed to be included in the basket are rated on a graph, allowing the committee to prioritize cheaper and more effective medicines.

Research conducted by the Gertner Institute indicated that every state employs a different set of priorities when choosing to subsidize a medication. France does not consider cost versus effectiveness, only Canada and Israel explicitly consider the number of patients, and the UK and Australia do not bring alternative treatments into their considerations.

"Our purpose was to create a tool for assisting decision-making that will calculate all aspects," Tal said at the conference. Sources at the Gertner Institute stressed that the software is not intended to replace the committee members in the process, but merely to help them make their choices. The software was submitted for Health Ministry testing some months ago, and last week was introduced to the new chairman of the health basket committee, Rambam Hospital director Prof. Rafael Beyar, who is expected to test it over the coming days.

The health basket committee began this week to discuss the 420 new medications and technologies proposed to be included in the basket for 2010. The committee has NIS 415 million at its disposal, but deputy health minister Yaakov Litzman recently announced that some of that budget will be diverted to providing free dental care.

The committee said in a statement to Haaretz that "although there are many models for technological prioritizing, none of the models, to our knowledge, can replace the multidisciplinary decision making practiced by the committee, comprising as it does of professionals from a variety of fields. We have been proposed an updated version of this model, and the matter needs to be examined further before a decision is made."

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