Cost of outpatient hypertension pharmacotherapy-comparative study between Bulgaria and Serbia

Abstract

OBJECTIVES: Pharmacotherapy costs represents huge burden for health institutions. The aim of the study is to compare pre- scribing practice and cost of outpatient hypertension pharmaco- therapy between Bulgaria and Serbia. METHODS: A one year retrospective study from the point of view of the health system was performed, based on the collected reimbursed prescriptions with diagnosis AH (I10–I11) and for its complications—heart failure (I.50); sequelae of cerebrovascular disease (I.69); angina pectoris (I.20). Therapy was analysed according to the complex- ity (mono-, di-, etc.), frequency of prescribed medicines, reim- bursed drug prices, and patient co-payment. To calculate the cost of the outpatient therapy was build a decision tree model match- ing the frequency of particular brand name prescribing, their prices, and complexity of therapy. RESULTS: The relative share of uncomplicated hypertension is comparable (67% in Serbia and 65% in Bulgaria). The ACE inhibitors are the first choice for hypertension treatment in both countries. Hypertension mono- therapy differs significantly (47% in Bulgaria and 6% in Serbia), while di-therapy is comparable (35% and 30%). Among the complications prevails prescriptions for angine pectoris (70% in Serbia and 42% in Bulgaria) and heart failure (7% and 26%). The complications are usually treated with more than one medi- cine in Serbia while the monotherapy in Bulgaria is 66%. By including the cost and prevalence of mono-, di- etc therapy in the “decision tree” model we receive that the waged monthly cost of outpatient pharmacotherapy per patient with uncomplicated hypertension account for €12.56 in Serbia and €6.90 in Bulgaria. The total monthly cost of hypertension considering the chance of having complications is €13.39 in Serbia and €8.23 in Bulgaria. Patient co-payment in Bulgaria is higher. CONCLUSIONS: Inter- national cost comparisons are possible but depend on many external factors as regulatory and price control measures, pre- scribing habits, reimbursement policy.