Researchers: Dan Greenberg¹, Ronen Arbel²

Background: New treatment modalities may improve health outcomes but are associated with substantial costs and budget impact, thus limiting the number of patients that may benefit from them. An alternative is implementing substantially lower cost interventions, accepting inferior per-patient outcomes to a much larger population, thus maximizing health outcomes.

Objectives: 1. To compare the effect of technology alternatives on the entire intended use population, under a pre-specified budget constraint, by using an innovative health technology assessment (HTA) model;
2. To assess the attitudes of policymakers and other stakeholders towards the feasibility of implementing the proposed policy in the healthcare system in Israel.

Method: 1. The model was examined by evaluating the efficacy of new oral anticoagulation therapy (NOAC) versus warfarin therapy in patients with atrial fibrillation;
2. In-depth interviews with 24 decision-makers and other stakeholders.

Findings: There is a significant advantage to NOAC in extending patients' life expectancy compared with warfarin. However, a large proportion of the target population is not treated at all, with significant implications for mortality rates. The findings from the in-depth interview present the feasibility of the proposed model in a variety of scenarios in the healthcare system.

Conclusions: Our case study demonstrated the importance of examining the impact of health interventions on the entire target population, and including also untreated patients in the economic models. The feasibility of implementing the proposed model is accompanied by many dilemmas that arose from the analysis of the in-depth interviews, as well as suggestions for a solution.

Recommendations: We recommend that the Ministry of Health will conduct a series of discussions about the feasibility, implementation, and impact of such a policy in the Israeli healthcare system.

Research end date: 05/2018