Presentation (CTI)

OBJECTIVES: Cardiovascular diseases are the leading cause of morbidity and mortality in Bulgaria. Lipoprotein(a) [Lp(a)] is a genetically determined LDL-like particle and independent predictor of residual cardiovascular risk, including atherosclerotic cardiovascular disease (ASCVD), myocardial infarction, stroke, aortic valve stenosis, and heart failure. Despite international recommendations for once-in-a-lifetime Lp(a) testing, the test is not routinely reimbursed in Bulgaria, limiting prevention. This analysis estimated the return on investment (ROI) of reimbursing one-time Lp(a) testing in Bulgaria from the National Health Insurance Fund (NHIF) and societal perspectives.
METHODS: An economic ROI model was developed over a lifetime horizon. Three populations were assessed: individuals without previous ASCVD events eligible for primary prevention, individuals with previous ASCVD events eligible for secondary prevention, and the general population turning 40 years of age. Monetary benefits included payer savings from avoided myocardial infarctions and strokes, and added gross domestic product (GDP) contribution among working individuals due to gained quality-adjusted life years (QALYs). ROI was calculated as total monetary benefits relative to testing costs.
RESULTS: In the primary prevention cohort aged 40-69 years, 267,516 individuals were tested, with testing costs of €3.09 million and total monetary benefits of €193.07 million. This corresponded to an ROI of +6,149%, or €62.49 per €1 invested. In the secondary prevention cohort aged 60 years and older, 7,984 individuals were tested, with costs of €92,210.49 and benefits of €22.32 million, resulting in an ROI of +24,104%, or €242.04 per €1 invested. In the general population cohort, 42,388 individuals were tested, with costs of €489,577.87 and benefits of €52.99 million, producing an ROI of +10,724%, or €108.24 per €1 invested.
CONCLUSIONS: One-time Lp(a) testing in Bulgaria is associated with substantial economic value across all scenarios. The findings support structured implementation and reimbursement of Lp(a) testing as part of national cardiovascular prevention strategies.