Analysis of Healthcare Expenditures in Bulgaria

Mitkova, Zornitsa; Doneva, Miglena; Gerasimov, Nikolay; Tachkov, Konstantin; Dimitrova, Maria; Kamusheva, Maria; Petrova, Guenka

doi:10.3390/healthcare10020274

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Access to all cancer drugs follows a similar regulatory pattern and challenges [83], resulting in comparable postauthorization delays. However, cancer ODs carry a significantly higher price, mostly attributed to the non-targeted oncological therapies and conventional chemotherapy included in the non-orphan category [84,85].…”

Section: Discussionmentioning

confidence: 99%

Availability and Access to Orphan Drugs for Rare Cancers in Bulgaria: Analysis of Delays and Public Expenditures

Kostadinov,

Popova-Sotirova,

Marinova

et al. 2024

Cancers

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Rare cancers are defined by an annual incidence of fewer than 6 per 100,000. Bearing similarities to rare diseases, they are associated with substantial health inequalities due to diagnostic complexity and delayed access to innovative therapies. This situation is further aggravated in Southeastern European countries like Bulgaria, where limited public resources and expertise underscore the need for additional policy and translational research on rare cancers. This study aimed to explore the availability and access to orphan drugs for rare cancers in Bulgaria for the period of 2020–2023. We cross-compared data from both the European Union and national public sources to evaluate the number of available and accessible orphan drugs for rare cancers, the delay from market authorization to reimbursement, the dynamics of public expenditures, and regional disparities in access across the country. We juxtaposed the main characteristics of oncological and non-oncological orphan drugs as well. Only 15 out of 50 oncological orphan drugs that were authorized by the European Medicine Agency were accessible for rare cancer patients in Bulgaria. The median delay between market authorization and inclusion in the Bulgarian Positive Drug List was 760 days. The total expenditures for all orphan drugs for rare cancers amounted to EUR 74,353,493 from 2020 to 2023. The budgetary impact of this group rose from 0.24% to 3.77% of total public medicinal product expenditures for the study period. Rare cancer patients represent a vulnerable population that often faces limited to no access to treatment. We call for targeted European and national policies to address this major inequality.

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Section: Discussionmentioning

confidence: 99%

Availability and Access to Orphan Drugs for Rare Cancers in Bulgaria: Analysis of Delays and Public Expenditures

Kostadinov,

Popova-Sotirova,

Marinova

et al. 2024

Cancers

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“…European countries have spent on average 9.6% of their gross domestic product (GDP) on healthcare in 2017 and 9.92% in 2019. Germany, France, and Sweden reported the highest healthcare expenditures in Europe in 2018 (between 10.9% and 11.5% of GDP) [ 5 ]. In the U.S., healthcare spending consumes 18% of the GDP, which is likely to eclipse $6 trillion by 2027 [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Hospital performance evaluation indicators: a scoping review

Hadian,

Rezayatmand,

Shaarbafchizadeh

et al. 2024

BMC Health Serv Res

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Background Hospitals are the biggest consumers of health system budgets and hence measuring hospital performance by quantitative or qualitative accessible and reliable indicators is crucial. This review aimed to categorize and present a set of indicators for evaluating overall hospital performance. Methods We conducted a literature search across three databases, i.e., PubMed, Scopus, and Web of Science, using possible keyword combinations. We included studies that explored hospital performance evaluation indicators from different dimensions. Results We included 91 English language studies published in the past 10 years. In total, 1161 indicators were extracted from the included studies. We classified the extracted indicators into 3 categories, 14 subcategories, 21 performance dimensions, and 110 main indicators. Finally, we presented a comprehensive set of indicators with regard to different performance dimensions and classified them based on what they indicate in the production process, i.e., input, process, output, outcome and impact. Conclusion The findings provide a comprehensive set of indicators at different levels that can be used for hospital performance evaluation. Future studies can be conducted to validate and apply these indicators in different contexts. It seems that, depending on the specific conditions of each country, an appropriate set of indicators can be selected from this comprehensive list of indicators for use in the performance evaluation of hospitals in different settings.

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“…On the other hand, the quality of the healthcare systems is highly dependent on the amount of healthcare expenditures, which may significantly influence the overall mortality in the country [ 4 , 5 , 6 ]. For example Bulgaria is the country with the lowest healthcare expenditures in the EU and with the shortest life expectancy in the pre-pandemic years [ 7 ]. Lower healthcare expenditures affect more severely vulnerable patient groups such as elderly and chronically ill people including cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Relative Risk of Death in Bulgarian Cancer Patients during the Initial Waves of the COVID-19 Pandemic

Shivarov,

Grigorova,

Yordanov

2023

Healthcare

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Background: The COVID-19 pandemic has led to millions of documented deaths worldwide, with diverse distribution among countries. Surprisingly, Bulgaria, a middle-income European Union member state, ranked highest in COVID-19 mortality. This study aims to assess whether Bulgarian cancer patients experienced a higher relative risk (RR) of death compared to the general Bulgarian population during the pandemic. Materials and Methods: Data from the Bulgarian National Statistical Institute and the Bulgarian National Cancer Registry were analyzed to estimate monthly RR of death in cancer patients compared to the general population before and during the first two years of the pandemic. The impact of the COVID-19 waves and predominant SARS-CoV-2 variants on RR was evaluated on various cancer types and age groups using a multiple linear regression approach. Results: During the COVID-19 waves, both the general population and cancer patients experienced a significant increase in mortality rates. Surprisingly, the RR of death in cancer patients was lower during pandemic waves. The results from the statistical modeling revealed a significant association between the COVID-19 waves and reduced RR for all cancer patients. Notably, the effect was more pronounced during waves associated with the Alpha and Delta variants. The results also showed varying impacts of the COVID-19 waves on RR when we analyzed subsamples of data grouped depending on the cancer type, age and sex. Conclusions: Despite increased overall mortality in Bulgarian cancer patients during the pandemic, the RR of death was lower compared to the Bulgarian general population, indicating that protective measures were relatively effective in this vulnerable group. This study underscores the importance of implementing and encouraging preventive measures, especially in cancer patients, to mitigate the impact of future viral pandemics and reduce excess mortality.

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Analysis of Healthcare Expenditures in Bulgaria

Cited by 5 publications

References 28 publications

Availability and Access to Orphan Drugs for Rare Cancers in Bulgaria: Analysis of Delays and Public Expenditures

Availability and Access to Orphan Drugs for Rare Cancers in Bulgaria: Analysis of Delays and Public Expenditures

Hospital performance evaluation indicators: a scoping review

Relative Risk of Death in Bulgarian Cancer Patients during the Initial Waves of the COVID-19 Pandemic

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