Cost of outpatient hypertension pharmacotherapy - comparative study between Bulgaria and Serbia
Objective: To compare the prescribing practice and pharmacotherapy outpatient cost of hypertension and its common complications between two neighboring countries, Bulgaria and Serbia. The study questions focus on consistency of the prescribing practice with the treatment guidelines; comparability of the treatment patterns among both countries, and burden of hypertension cost to the population and third party payer in the countries under consideration.
Methods: Retrospective study, one year time horizon is for outpatient therapy.
Results: Patients with arterial hypertension in Bulgaria are most often on monotherapy (61% vs 6% in Serbia), as well as those with complications (66% vs 0% Serbia). In both countries the first choice of therapy are the ACE inhibitors (37.01% in Serbia and 41% in Bulgaria) and then follows the calcium antagonists, beta-blockers, and diuretics. The weighed monthly cost of hypertension and complicated hypertension is almost doubled in Serbia (12.56 vs 8.23 EUR for hypertension, and 13.39 vs 8.23 EUR) and prevailing part is reimbursed (88% vs 44% in Bulgaria).
Conclusion: Our study confirms that hypertension and its complications therapy consumes a huge amount of financial resources. In both countries under consideration the therapy is corresponding with the European treatment guidelines. The international cost comparisons are possible but they depend on many external factors as the regulatory measures, prescribing habits and reimbursement policy and should be analysed within this framework.
2. WHO. Core health indicators. Avail. at: http://www.who.int/whosis/database/ core_core_select_process.cfm Accessed (accessed October 08, 2008).
3. National Statistic Institute of Bulgaria. Reasons for death 2007. [ In Bulgarian] Available at: http://www.nsi.bg/SocialActivities/Health.htm. (accessed July 30, 2008).
4. Sans S, Kesteloot H, Kromhout D; Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. The burden of cardiovascular diseases mortality in Europe. Eur Heart J. 1997;18:1231-1248.
5. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas A.M., Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA project: Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994;90:583-612.
6. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21:1011-1053.
7. International classification of diseases. ICD 10. Available at: www.who.int/classifications/apps/icd/icd10online (accessed June 11, 2007).
8. National health insurance fund. Amendment 2 to “ Instruction for usage of drug list of NHIF (Amendment 11 of National Agreement 2006, State Gazette 106/2005) in force from 01 September 2006-work version for-pharmacy. Available at: http://www.nhif.bg/bg/default.phtml?w=800&h=570 (accessed September 15, 2006).
9. RHIF. Ordinance on Drug Price List. RHIF, 2007 http://nn01.statserb.sr.gov.yu/axd/pxweb2004/Dialog/Saveshow.asp (accessed/ 09.04.2008).
10. WHO health data basis. Available at: http://data.euro.who.int/hfadb/ (accessed May 4, 2006).
11. http://www.heartstats.org/datapage.asp?id=4541(accessed/poslednji pristup: 06.06.2008).
12. Liu JL, Maniadakis N, Gray A, Rayner M. The economic burden of coronary heart disease in the UK. Heart. 2002;88:597-603.
13. Marković Bergman B, Kranjčević K, Reiner Ž, Blažeković Milanković S, Špehar Stojanović S. Drug Therapy of Cardiovascular Risk Factors: Guidelines versus Reality in Primary Health Care Service. Croat Med J. 2005;46(6):984-989.
14. Marques-Vidal P, Montaye M, Ruidavets JB, Amouyel P, Ferrieres J. Evolution and Cost Trends of Antihypertensive and Hypolipidaemic Drug Treatment in France. Cardiovas Drugs Ther. 2003;17:175-189.
15. Petrova GI, Ivanova AD. Study of the cost of outpatient hypertension therapy in Bulgaria. Value Health. 2007;10(6):A417-A418.