OBJECTIVES : To analyse the public expenditures for medicines and prescribing practice for psychotic disorders therapy in outpatient settings in Bulgaria during 2013-2018.

METHODS: It is a retrospective, quantitative study based on officially published information by the National Health Insurance Fund for all reimbursed patients and indications. Number of patients with ICD codes of diseases from F20.0 to F33.4 during 2013-2017, which received outpatient prescriptions were analysed via time series analysis. Reimbursed sum for medicines with ATC codes N04; N05; N06 and indications for psychotic disorders therapy was also collected. Changes in medicines prescribing and utilisation were analysed through calculation of the DDD/1000inh/day (DID) for the period 2013-2018. Descriptive statistic, t-test, z-test were performed.

RESULTS : Reimbursed patients from the selected ICD codes decreased from 62,436 to 53,941 with linear trend (y = -2238.9x + 64916). Patients with ICD code F20.0 paranoid schizophrenia prevail (46%), followed by 25% with moderate depression (F33.1).

On average 31 INNs of medicines from 12 therapeutic groups were reimbursed during 2013-2018. Their overall utilization performed a decrease from 28.04 to 16.63 DID. Olansapine utilization is with high rate (from 13.40 to 8.75 DID). The cost of reimbursed medicines also decreased from 17,863,772 to 15,880,602 Euro, respectively. The average, yearly, per patient cost of reimbursed medicines amounted to 286 and 295 Euro, for 2013-2018 respectively. All changes were found to be statistically significant.

CONCLUSIONS : Psychotic disorders pharmacotherapy cost on average 16 million Euro. Although the number of patients and total cost of therapy decreased on average, yearly per patient cost increased.