OBJECTIVES:To evaluate the reimbursed cost and utilization of ACE- inhibitors and sartans in Bulgarian for a 4-year period.

METHODS: A retrospective and observational cost and utilization analysis of 15 International Nonproprietary Names (INNs), acting on cardiovascular system (ATC C09C and C09A), reimbursed by the National Health Insurance Fund (NHIF), is performed. Data was collected from the NHIF official register. Medicines utilization is measured by using the following formula: DDD/1000 inhabitants/day = ((Sales in mg/ DDD)/(number of inhabitans×365)×1000). Reimbursed cost during 2015 – 2018 has been compared. Statistical significance was of the changes in reimbursed cost during 2015 and 2018 was tested with t-test.

RESULTS:The largest share of all reimbursed costs has been paid for enalapril (21%) and lisinopril (27%) from the group of ACE- inhibitors, as well as valsartan (32%) and telmisartan (25%) from the group of sartans.

The reimbursed costs for most of the products have decreased during the observed period. A clear trend of increasing reimbursed cost is observed for candesartan (from 168,346 to 256,071 Euro) and irbesartan (from 56,608 to 159,486 Euro) only.

The results from the applied t-test show that there are no statistically significant differences between reimbursed cost in 2015 and 2018 (p>0.05).

The highest utilization in DDD/1000 inhabitants/day is measured for ramipril (17.4),valsartan (13.4), enalapril (12.2) and lisinopril (10.01), thus confirming that the medicinal products established in the practice continue to be utilized in a high rate.

CONCLUSIONS: ACE- inhibitors and sartans are among the products with the highest consumption in Bulgaria. Although the reimbursed cost is decreasing during the observed period, it still remains significantly high. The products established on the market continue to be utilized in a very high rate, despite the new products entrance and the therapeutic competition in this area.