Nissanholtz-Gannot Rachel, Chinitz David
Department of Health System Management, Ariel University, University Hill, 40700, Ariel, Israel.
Myers-JDC-Brookdale Institute, Jerusalem, Israel.
Isr J Health Policy Res. 2018 Jan 4;7(1):3. doi: 10.1186/s13584-017-0195-7.
Avisar et al. present an exemplary model for outreach aimed at ensuring that a maximum of patients eligible for expensive Hepatitis C (HPC) drugs receive treatment. We enlarge the picture to put their model in the political, economic and regulatory framework for financing and providing these drugs in Israel and a number of other countries. We then return to delivery system level and consider issues such as cost of outreach, the need for health care coordinators and dealing with Hepatitis C patients not yet entitled to receive the drugs under national health coverage determinations.Regarding national coverage decisions, we find that countries such as Australia, New Zealand, the United Kingdom and Israel all extended coverage for Hepatitis C drugs, given the clear high effectiveness of the latter. However, to limit budget impact, all these countries target coverage to patients based on disease genotype and stage.The model presented by Avisar et al., while impressive, leaves some items to address. These include: whether all resources allocated to HPC drugs are actually used for this purpose, the roles of outreach to HPC patients who do not meet the guidelines for treatment, and a comparison of the effectiveness of the model vs. a variety of costs associated with it.
阿维萨尔等人提出了一个堪称典范的推广模式，旨在确保尽可能多符合条件的丙肝患者能够获得昂贵的丙肝治疗药物。我们将范围扩大，把他们的模式置于以色列及其他一些国家为这些药物筹资和提供的政治、经济及监管框架之中。然后，我们回到递送系统层面，考虑诸如推广成本、医疗协调员的需求以及处理那些根据国家医保规定尚无资格获得药物的丙肝患者等问题。关于国家医保覆盖范围的决定，我们发现，鉴于丙肝药物具有明显的高效性，澳大利亚、新西兰、英国和以色列等国家都扩大了丙肝药物的覆盖范围。然而，为了限制对预算的影响，所有这些国家都根据疾病基因型和阶段来确定患者的覆盖范围。阿维萨尔等人提出的模式虽然令人印象深刻，但仍有一些问题有待解决。这些问题包括：分配给丙肝药物的所有资源是否实际用于这一目的、对不符合治疗指南的丙肝患者进行推广的作用，以及该模式与各种相关成本的有效性比较。
