OBJECTIVES: At the end of 2015, 426 patients from Bulgaria were recruited by pneumologists across the country to participate in a prospective cohort study of Chronic Obstructive Pulmonary Disease (COPD) and were followed for 3 year period. Here we report data for patient status, pharmacotherapy changes, mortality, as well as costs.

METHODS: This is a prospective, multi-center, observational, randomized, representative, and comparative real-life study of previously diagnosed patients with COPD from 5 main regions - North-east Bulgaria [NEB], North-West Bulgaria [NWB], South-east Bulgaria [SEB]. South-west Bulgaria [SWB] including Sofia city. Patient characteristics, therapy costs and outcomes were analyzed and compared to results from 2016-2017. Statistics was done through MedCalc software version 14.8.1

RESULTS: At the end of year three, 406 patients remained in the study. Patients distribution according to severity of COPD are: GOLD A – 31 (7.38%); GOLD B – 145 (34.76%); GOLD C – 63 (15.24%); GOLD D – 161 (42.62%) for 2018, vs 30,149,65, and 182 in 2015, respectively. 22 patients had died, with 20 of them being in GOLD D. Median age was 66 years (65-68 years 95%CI) with 132 patients (31.36%) experiencing a change to pharmacotherapy compared to previous years, with 35 recorded instances of improvement and 44 instances of worsening of COPD symptoms. Average number of exacerbations was 2.10 (1.94-2.27 95%CI) with no significant change. Median monthly costs of pharmacotherapy were: 59.63 BGN paid by the NHIF (43.41-59.63 96%CI) and 13.08 per patient as co-pay. The cost of group C decreased due to deceased patients, cost in group A and B remain constant, and cost in group C increased.

CONCLUSIONS: The main cost driver appears to be the severity and mortality of patients with insignificant changes in other health care resources used and significant changes in pharmacotherapy.