Anti-smoking drugs in health basket

Anti-smoking medication

By JUDY SIEGEL-ITZKOVICH
Smokers who want to kick the habit will for the first time soon be able to attend cessation courses covered by their health funds, as well as ask their doctor for subsidized medications that help overcome nicotine addiction. These will be among the 80 drugs and technologies, worth NIS 350 million, chosen by the public committee responsible for recommending medical technologies for inclusion in the 210 health basket The choices were selected from hundreds of products costing a total of NIS 2 billion. Following two months of deliberations and recent controversy over Deputy Health Minister Ya'acov Litzman's success in reducing the NIS 415 million basket increase by NIS 65m. as seed money for free pediatric dental care, committee chairman Prof. Rafael Beyar presented the list at a press conference in the Knesset lecture room. Drug and technology companies and patient groups had lobbied hard and conducted expensive public relations campaigns to get their products into the basket, which is subsidized by the Treasury. However, the highly professional, 16-member committee - all volunteers - made their recommendations on an objective basis, insisted Litzman and his ministry director-general, Dr. Eitan Hai-Am. The drugs and other technologies selected, said Beyar, included prescription medications for a large variety of medical specialties, that would benefit an estimated 70,000 Israelis. Smoking cessation through courses and medications Zyban and Champix, said Beyar, was a worthwhile addition because "the most expensive oncological drug could not prevent years of disease [the way] these can." The courses were added to the basket at the last minute, as the committee, which spent hundreds of hours in deliberations, concluded them around midnight Tuesday. About NIS 6m. was set aside for fighting nicotine addiction - estimated as enough to cover 6,000 Israelis; it was not clear what would happen if many more people demanded it. Not all the technologies were new; some drugs already in the basket had their medical indications expanded. Some Parkinson's disease patients, for example, may now be prescribed Azilect, which can slow the deterioration of the patient's condition. Kidney cancer patients were allotted the most expensive drug in the basket, at a cost of NIS 34m. Alzheimer's patients and schizophrenics will also receive cutting-edge treatment as a result of the council's decision. Among the new medications or drugs already in the basket with new indications are Erbitux, Iressa, Afinitor, Sutent, Nexavar, Temodal, Torisel, Gemzar, Glivec, Mozobil, Vigam, Thyrogen and Revlimid for cancer; Intelence for AIDS; Mimpara and Aclasta for endocrinology; Xarelto, Pradaxa and Soliris for hematology; Multaq, Inspra and Rqasilez for cardiovascular disease; Eraxis for infections; Avonex, Aricept, Exelon, Provigil and Targin for neurology; Byetta and Victoza for diabetes; Humira, Enbrel, Remicade and Amevive for dermatology; Abilify for psychiatry; Spiriva for lung disease; and Combigan for eye disease. New medical technologies on the list include an artificial heart valve that can be inserted with a catheter rather than by open-heart surgery and special MRI-mammography scanning for better detecting breast cancer in certain patients. The entire list of the additions to the basket is available on the Health Ministry Web site (in Hebrew, with English names of drugs) at www.health.gov.il. Sixty percent of the drugs are lifesaving, and the rest life-extending and -improving technologies. Beyar said all the committee members had done outstanding work, and had received a huge amount of in-depth, updated background material from ministry deputy director-general Dr. Yoel Lipschitz, who supervises the health funds, and Dr. Osnat Luxenburg, who heads the medical technology branch. Beyar said that Israel's mechanism for updating the basket was among the best - if not the most advanced - in the world. Prof. Elliot Berry, a leading metabolism and nutrition expert at Hadassah University Medical Center and a first-time member of the committee, told The Jerusalem Post that the demanding experience "was one of the most exciting and impressive experiences of my life" because of the professionalism of the members and ministry staffers. "Seven staffers prepare the material for the committee's deliberations, while the same job is carried out in the United Kingdom by 250," he said. Berry added that even though it was a difficult job, he would be happy to serve on next year's committee. The Israel Medical Association (IMA) commented that vital lifesaving medications, such as Avastin for metastasizing breast cancer and three drugs that would have saved rheumatology patients from serious disability, had not made it into the basket. Israel Rheumatology Association chairman Prof. Moshe Tischler said the three drugs would have enabled patients with rheumatoid arthritis, which affects mostly young women, to have a normal life, but that now they would face disability. Dr. Bella Kaufman, head of the breast cancer unit at Sheba Medical Center, said she would have difficulty "looking patients in the eye" after Avastin was not put in the basket, at the cost of NIS 58m., for a large group of patients "who have been waiting breathlessly for January 1." IMA deputy chairman Dr. Yitzhak Ziv-Ner said that "we now see the results of the decision to cut the basket increment by NIS 65 million. This is testimony to the fact that the committee did not insist" that the money not be deducted, he declared. "As a physician who sees suffering patients every day, I feel great sorrow over the way the government handled this," he said. The Israel Cancer Association said it welcomed the addition of every new cancer drug and measure raising awareness of the need for prevention, especially regarding smoking, but regretted that some of the "most important cancer drugs" that it recommended were ignored. Meanwhile, regarding the Post's story Tuesday that Litzman had said Monday during a speech at Bar-Ilan University that there was no labelling of food suitable for diabetics (when in fact the Israel Diabetes Association has been doing it for 15 years), the deputy minister said he meant to say that foods lacking the IDA's approval often contained "hidden sugar" and other substances that could be harmful to diabetics.