Drug Basket 2020: Emphasis on Cancer, HIV War, and Treatment of Depression

After lengthy discussions, the Hessel Committee decided which patients would receive treatment next year and which did not. The low budget and many treatment technologies have left important drugs out, but there have been some breakthroughs in various areas. "We fight for our medical conscience and our social role"

Drug Basket 2020: Emphasis on Cancer, HIV War, and Treatment of Depression

The drug basket committee decided tonight (Friday) which drugs will enter the basket this year, and made its recommendations to Health Minister Jacob Litzman. According to the decision, signed at 1:30 PM, 141 different medical labels are expected to go into the basket and will provide assistance to 210,000 people in Israel as of February, with some 750 remaining outside. The committee this year discussed some 900 technologies, treatments and medicines under a budget of NIS 500 million. This, despite Litzman's commitment to increase the basket to NIS 700 million.

The chairman of the Hessel committee, Prof. Ze'ev Rothstein, remarked to the committee members many times in the past two days, known as the "marathon days," after the committee members had difficulty giving up some of the drugs and technologies. "We had weeks to discuss. We want to help the public, "he said. A committee member replied:" We have to do things with the utmost heart, otherwise no one sitting here can live with himself. At the end of what matters is what we take down. We have to be confident in the million percent that the things we leave are true in the million percent compared to what we leave out. "

Full list of medicines for 2020

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Members of the Drug Basket Committee this morning at the Ministry of Health (Photo: Avi Cohen)

Health Minister Yaakov Litzman and Chair of the Hessel Committee, Prof. Zeev Rothstein at a Press Conference to Announce the Drug Basket 2020, Jerusalem, January 7, 2020 (Photo: Avi Cohen)

Late last night, a member of the committee said in response to comments from its members that the existing budget was insufficient and that the basket could not be completed in that framework, "there is no extra missile defense, nor the Ministry of Health. There are many things waiting. Renovation of departments ... The entire state budget is waiting But the basket committee started with $ 500 million. I don't think you realize how much effort it would have taken. There will be no extras, no where to bring them. Every year is hard, and building on the future is not smart. No, we will go back to our original work of 500 million and prioritize it within that. "

200 treatments, half a billion shekels: everything you need to know about the medicine basket

Advanced Cancer Treatment

As in previous years, most of this year's budget was also devoted to oncological and meta-oncological diseases for those with cancer. The drugs are divided into those that fight tumors by boosting the immune system (immunotherapy) and direct tumors. Among the drugs that have been decided to include in the basket are lymphoma patients, widening the cervical survey to detect cancerous lesions through a PAP test for girls 25-30, screening for mutations in Ashkenazi Jewish women aged 30-35, head and neck cancer treatments, lung cancer treatments, breast cancer treatments , Ovarian cancer treatments and kidney cancer treatments.

This year, too, most of the basket's budget was devoted to cancer patients. Chemotherapy treatment (Photo: ShutterStock)

Chemotherapy (Photo: ShutterStock)

Option - a helmet for treating brain cancer through electric fields - has also been selected to enter the basket. The cost of treatment is about NIS 150,000 per patient, and is intended for 148 patients. Its total cost - about NIS 20 million. "It's a disease that has no breakthroughs. It's a technology that works in a completely different way. 20% survival after four years is at least as good as other oncology drugs we've put forward," said one company.

Throughout the discussions, members found it difficult to cut down on the important treatments for cancer, and again and again discussions were held to determine which drugs would not enter the basket. "We don't hide the enormous difficulty in making decisions. We are fighting for our medical conscience and social role," said one of the members.

The surprise of the butterfly and the exciting discussion about depression treatment

Unexpectedly, Prep, the antidote for HIV infection, entered the drug basket this year. In the first phase of the debates, controversial statements were raised against her, as first published in Walla! NEWS. "If I were in Botswana I would give it a high rating," one friend said. "If we approve it, there could be complete freedom here," said another. In addition, additional treatments for HIV carriers were introduced at no additional cost.

In the mental health field, it was decided to put in the basket after many years of ignoring the field, treating durable depression with spray. It is a drug that has cost about NIS 15,000 and is intended for 1,558 people suffering from depression. Its total cost is estimated at about NIS 24 million.

"It may be that if we approve it, there will be complete freedom here." HIV test (Photo: AP)

HIV test stand in Tehran, Iran, November 2017 (Photo: AP)

The discourse on the introduction of the drug, Sparaveto, stirred a sensitive debate. "Not every day comes a cure for depression," said one member of the committee. "It is the most common disease in the world, causing mortality, and anything that helps fight the chance of suicide should not be ignored. We do not have any studies to show that it eliminates or prevents suicide, but there is a one-year and four-month gap in depression recurrence between those who took the drug and who Who took placebo (dummy medicine - BA). It's advanced therapy, not first line. Mental health did not receive a response from the basket committee most of the time. Until something impressive is reached on such an important issue, a drug designated as a breakthrough by the FDA should not be taken down. "

"I totally agree," replied another friend. "It's a mistake to take the medicine off. I think it's a very important thing for quality of life and for preventing mortality." Other members joined her. "I agree. Alternative treatments are sometimes awful. Electric blows ...," said one. "From what I know, this medicine is considered a miracle, it is starting to work fast. There is an opportunity to stop the treatment of electricity," said another.

"The shopping budget of psychiatric hospitals is lower than the drug budget of Nahariya Hospital." Abarbanel (Photo: Bernie Ardov)

Abarbanel Mental Health Center (Photo: Bernie Ardov)

Rothstein (Photo: Megad Guzni)

One member of the committee stressed that the drug is intended for the "weakened, muted and tagged population. I see the messages I receive about every disease (from specialists and professionals), and I have not received a single mental health message from anyone. I will stand outside the city. I will not absorb the drug ".

"Depression and suicides are most common in the 15-30 age group," another member added. "If we were able to prevent suicides there and save lives, it's not a few months or six months - you can give a lifetime to a human being."

Another member emphasized the added value of treating depression. "It has economic effects on the labor market," he said. "The shopping budget of the eight psychiatric hospitals is lower than the Nahariya Hospital's drug budget. There are no technologies today, no wonder drugs."

Treatments for special diseases

As part of the committee's decisions, it was decided to introduce costly treatment, which by means of a disposable injection can introduce a proper gene that improves vision, proportionally, and even stops retinal degeneration and prevents blindness. In the field of neurology, treatments for multiple sclerosis, narcolepsy (sleep sickness) and muscular dystrophy have been expanded. In pulmonary medicine, treatments for severe asthma were introduced, COPD treatment was expanded, and it was decided to provide rehabilitation for patients on a waiting list for lung transplantation and for patients after lung transplantation for one year. In the field of liver disease, this year the first treatment for Crohn's patients was introduced after failure of conventional and biological treatment in the PERFORMANCE program under which the pharmaceutical company will only pay for successful treatments.

As for diabetes, the Hessel Committee introduced a technology called Flash for child sugar monitoring and expanded continuous monitoring of adult sugar and disease treatment. In the field of nutrition, dedicated foods were added to cancer patients at risk of malnutrition and special foods were introduced to various patients at no additional cost. In the field of cardiology, stroke prevention and systemic embolism have been introduced in patients with ascites and secondary prevention of cardiac events.

Vaccination for measles, mumps and rubella was put in the basket (Photo: Image Bank GettyImages)

Vaccination for mumps and measles (Photo: GettyImages)

In addition, screening tests for carcinogenic duodenal disease carriers have been expanded in the general population and carcinogenesis carriers for Arab societies and genetic diagnosis for the prevention of mutation in BRCA genes 1 and 2.

In the area of ​​the nose-throat, a decision was made to change the budgeting method for hearing aids for ages 51 to 64 to receive a refund of NIS 3,000 and to introduce an imaging test to diagnose complex conditions of infection and inflammation. As part of the vaccines, measles, mumps, and rubella vaccine, Meningococcus B vaccine was given to at-risk groups and the HPV vaccine was expanded from four to nine strains.

The last-minute fertility treatment

Towards the end of the discussions, after midnight, there remained a gap of slightly more than NIS 3 million. Subcommittee members were forced to convene and formulate advice on whether to leave a fertility preservation basket for women with low ovarian reserve. In the end, to the dismay of the members of the committee, it was understood that there was no other way to end the discussions without giving up the treatment, and so it was decided. In addition, among the treatments, drugs and technologies that did not go into the basket, Morcio treatment (rare genetic syndrome), retinal vein occlusion therapy, treatment of seizures based on dermal syndrome by cannabis-based drug, extension of eosinophilic asthma treatment, , Multiple myeloma treatments, DPP4 inhibitors for diabetes treatment and expansion of other treatments for disease, pancreatic metastatic cancer treatment, NSCLC metastatic lung cancer treatments, complementary melanoma treatments, prenatal non-invasive genetic screening test for pregnant women at one-third risk of treatment In bladder P. Villa more.

As for the treatment of pancreatic metastatic cancer that extends the life expectancy of the terminal patient by three months, a wide discussion was held in the committee. The drug costs NIS 27,000 per patient and is intended for 197 patients. Its total cost is estimated at NIS 5.3 million. "There is a line here and you have to put it in," one friend said. "We are not a holistic committee. If a poor person is poor he needs another step. To give a drug that is worth nothing ... In 20 years they will laugh at it. It is not really treatment. It does not help," said another. "It's not black and white, and the real difficulty here. As far as it hurts, these patients have nothing to give. The significance of the drug is not very great compared to the price," one member of the committee concluded.

So did the fate of life-extension therapy for patients with myocardial infarction, which cost NIS 267.5 thousand per patient and is intended for 344 patients. The total cost of treatment was measured in the largest amount - about NIS 89 million. Due to the high cost, one member of the committee suggested taking a symbolic step and putting the drug at the top of the list, outside the NIS 500 million, so that if the budget was indeed raised to NIS 700 million (as promised by the Minister of Health), it would be the first to enter. However, the friend said, "The chance of this happening is the same as the chance of having hair on my palm."

The recommendations were passed on to the Minister. The Director General of the Ministry of Health Moshe Bar Good Taken and the Minister of Health Yaakov Litzman

Food Marking Reform March 31, 2019 (Photo: Official Website)

One member emphasized the importance of extending the life expectancy of patients so that they might eventually receive treatment to cure their illness, comparing it to the fight against cancer. "Our cancer war is a war on time. Companies find five to ten molecules each year that fight the disease. It should not be taken as a definitive life expectancy. We are flooded with new molecules, and we can give patients a chance if we can give them more time."

Another committee member concluded that "experience with the drug has been accumulated over the years, also considering that its cost is high. Only Japan has put it in the basket, and before investing 20% ​​of the health basket in one drug is needed."

The committee has 21 members, leading professionals in the field from the Ministry of Health and the Ministry of Finance, doctors, public representatives, economists and representatives of the HMOs, which reflect a wide range of issues. In discussions, they are required to address the full range of medical, social, economic and ethical aspects for the benefit of patients.

Commission hearings began in November, and they took place in a dedicated structure at Sheba Hospital on average twice a week. In the first phase, the members discussed the practical value of the treatments and drugs, and in the second stage the economic aspect. For example, as every year, it has become questionable whether it is more important for an expensive drug for a few patients than for cheaper treatment for a wider public.

The AIDS War Committee and the Cancer War Association welcome

The AIDS War Committee, the LGBT Medicine Society and the Israeli AIDS Society, welcomed the decision to include HIV-preventive therapy in the drug basket for 2020. "Welcoming the historic decision to accept our request and to include HIV-preventable HIV therapy in the basket The basic. The availability of public funding treatment, for which we have been fighting for several years, is expected to significantly reduce the number of infections among various risk groups. This is an important step in eradicating new infections in Israel and reaching the long-term goal we are leading - ending the epidemic in ten years. In order to reach this goal, the government must allocate additional resources to the appropriate implementation of treatment use, which includes training, public information and encouraging testing. "

The Psychiatric Association also welcomed the inclusion of anti-depressant therapy in the drug basket. Dr. Zvi Fishel, chairman of the Israel Psychiatric Association, said: "The Psychiatric Association welcomes the basket committee for its correct decision to introduce a new treatment for durable depression. This is a new treatment designed for patients with depression who have not responded to conventional antidepressants and had no effective solution. So far".

On the publication of the drug basket for the coming year, the Israel Cardiology Association said they were pleased to include some very important drugs for cardiac patients, including PCSK9 inhibitors for cholesterol therapy, expanding the possibility of providing brilinta for patients with infarction, and expanding the inclusion in a basket of highly beneficial diabetes drugs for heart patients. "Unfortunately, a breakthrough drug for the treatment of amyloidosis has not been included in the basket, but the Cardiology Association will continue to struggle for it next year."

Drugs (Photo: Police spokeswoman - Merhav Negev)

Doctor and son are suspected of smuggling drugs that are dangerous drugs abroad, 11.09.19 (Photo: Police spokeswoman - Merhav Negev, official website)

The Cancer Society commented on a decision by the Medicines Committee, saying, "We are pleased that many patients will receive appropriate treatment due to the increase in the number of drugs and technologies entered this year. However, the joy is incomplete, as there are many drugs left out of the basket due to lack of Budget. We expect the government to set up a regular annual increase of 2% every year from the cost of the health basket immediately after the elections. This is an requested step designed to enable long-term solution and planning under the National Health Insurance Law, and to prevent distress from patients. "