[Economic examination of the 2006/7 update of the Israeli national list of health services]

Abstract

Background: The Public Committee bases its choices on clinical, ethical and social considerations, and not, in general, on the (minimal) cost per Quality Adjusted Life Year (QALY) of the technologies.

Objectives: To examine the Public Committee's 2006/7 decisions from an economic viewpoint.

Methods: The examination analyzes the findings from reviews of: 1) Recent studies which estimated the Value of Statistical Life (VSL), and hence the value of QALY, in Israel and abroad, and 2) Reports of the costs per QALY of the technologies adopted.

Results and conclusions: The paper recommends that the Israeli willingness to pay (WTP) for human life is set at NIS 10 million, for life year at NIS 200,000 and for QALY at NIS 250,000. While the Committee's ranking of the 40 technologies, on which data was found, does not match the ranking by cost per QALY, the cost per QALY of all but three (Avastin, Myozyme and Zomera) was below NIS 250,000, and of most of the technologies was below NIS 150,000. Apart from these cases--which can be argued for on social-ethical-political specific grounds--the costs per QALY are below the WTP. In order to achieve an efficient and equitable allocation of national resources to areas which improve safety and health, the social WTP for life and for QALY must be seriously and publicly discussed.