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Introduction: Breast cancer is one of the most common malignancies among women and significantly worsens physical, mental and social functioning. The aim is to evaluate the social and economic burden of treatment strategies for breast cancer in the North East region of Bulgaria. Areas covered: A retrospective, observational, population-based study among patients with breast cancer was performed. Patient characteristics, treatment patterns, and costs were assessed during a four-year period (2016–2019). Disability-adjusted life years (DALYs) were calculated to estimate the social burden. Results: Approximately 99% of patients (n = 1,373) were female and the mean age at diagnosis was 60.6 years. The total economic burden of breast cancer during the time of the study was estimated to be 21,076,809.12 BGN where the direct costs were equal to 19,634,509.67 BGN and the total indirect costs due to premature death amounted to 1,442,299.45 BGN. Total DALYs were 110.56 for all patients corresponding to 1,898,340.80 BGN. Conclusions: This study demonstrates the significant social and economic burden of breast cancer as further, more comprehensive regional and national-based studies related to the total economic burden of breast cancer are required. [ABSTRACT FROM AUTHOR]

The global market of monoclonal antibodies (mAbs) is growing very fast. The aim of this study is to analyze the reimbursed market of adalimumab and pemborlizumab in Bulgaria. A retrospective cost analysis of the reimbursed mAbs adalimumab and pemborlizumab for ambulatory and hospital settings, respectively, paid by the National Health Insurance Fund (NHIF) was performed based on official NHIF data. The share of their costs from the total mAbs costs was calculated. The results showed that the most cost-consuming mAbs were adalimumab in ambulatory and pembrolizumab in hospital settings: 31% and 31.59% in 2020 out of the total reimbursed mAbs budget, respectively. Regardless of the extension of the reimbursed therapeutic indications, the costs for adalimumab decreased from 25,575,836.32 Euro in 2018 to 20,493,187.02 Euro in 2019 as a result of inclusion of 3 biosimilars and international price referencing. Despite the reduction of the registered price with 20%, the pembrolizumab costs have almost tripled probably because of reimbursement of five additional therapeutic indications. Overall, the reimbursed costs for pemborlizumab have been increased every year as a result of reimbursement of new therapeutic indications and increase in the number of patients treated with mAbs. The adalimumab trend is for a stable decline in the reimbursed costs because of entrance of biosimilars. [ABSTRACT FROM AUTHOR]

Acromegaly is a rare disease with significant social and economic burden considering both main treatment patterns and concomitant diseases. The aim of this study was to present a systematic overview of the economic and pharmaco-economic studies of acromegaly treatment. A systematic search in PubMed and Google Scholar was performed following the validated five-step approach for preparing a systematic review of economic evaluations for informing evidence-based healthcare decision on the basis of predefined inclusion and exclusion criteria. To perform critical analysis of the selected articles, the costs on macrolevel and microlevel were extracted and inflated to 2018 for the purposes of their comparison. Of 100 studies, 33 ones were included in the present analysis, most of them being cost-of-illness studies (12), followed by cost-effectiveness analysis applying Markov modeling or decision tree models (9). The total costs for acromegaly patients in different countries as a percent of the gross domestic product (GDP) vary in the range between 0.00001% and 0.003%. The annual direct and indirect costs per patient vary in the range between 3,788 € and 93,970 € as a result of differences in the type of calculations. Acromegaly is a high-consuming rare disease, so it is urgent to provide economically based evidence in every country for the purposes of making the most suitable policy decisions in the healthcare sector. [ABSTRACT FROM AUTHOR]

Schizophrenia is a serious mental disorder which requires complex treatment and care. Although proof for effective, cost-effective and affordable treatment is available, health economic research is lacking in many low and middle-income countries. The aim of this study was to evaluate the costs and outcomes for individuals with acute exacerbations of schizophrenia before and after inpatient admission and to evaluate the cost-effectiveness of the current treatment in the clinical practice. We used an ambispective comparative observational health economic study design. The participants were individuals with schizophrenia and their primary caregivers. Costs at baseline and follow-up were evaluated from a healthcare perspective. The primary outcomes were psychopathology, social functioning and quality of life for the patients and burden of informal care for the caregivers. Cost-effectiveness planes and cost-effectiveness acceptability curves were generated to illustrate the cost-effectiveness of treating schizophrenia in the real clinical practice, compared to a do-nothing alternative. The main finding is that treatment of individuals with schizophrenia results in improved outcomes for both patients and caregivers, while it is associated with increased healthcare costs from 135.75 Euro (SD = 193.36) per patient before hospital treatment to 189.00 Euro (SD = 126.98) per patient in the follow-up (95% CI: −112.48; −2.31). After application of sensitivity analysis at a particular level of willingness to pay, the treatment remains cost-effective for all 4 outcomes. In conclusion, the treatment of patients with schizophrenia in Bulgaria is cost-effective at acceptable levels of willingness to pay for a unit of improvement on four different outcomes. [ABSTRACT FROM AUTHOR]