OBJECTIVES : Little is known in Bulgaria about the additional costs associated with treating comorbidities in these patients. Cost-containment measures help alleviate the burden on the payer, but that often comes at the expense of the patient. The purpose of this research is to estimate the mean number of comorbidities, number of medication and monthly costs per patient for both the national health insurance fund (NHIF) and patients in Bulgaria.

METHODS : from a prospective, observational, national study of 416 patients with Chronic Obstructive Pulmonary disease was analyzed. Number of comorbidities, cost of medication and their correlation with disease stage was established. Costs are presented in national currency (BGN) at an exchange rate of 1 BGN = 1.6$ USD

RESULTS : Patients within every disease stage had a median of 3 comorbidities (minimum of 1 and maximum of 9). Patients in GOLD C had the most prescribed medicines at 3.5 on average, while patients in GOLD B stage had the lowest number of prescribed medicines at 3.12. We confirmed a positive correlation between number of comorbidities and number of medications, number of diseases and cost of treating comorbidities (p < 0.01), but not for disease stage and number of comorbidities. Patient burden was twice higher than that of the NHIF with patients having to co-pay a median of 20.05 BGN (GOLD A) to 27.88 BGN (Gold C) for medication, whereas the NHIF covered between 13.21 BGN (GOLD D) and 27.17 BGN (GOLD A) per patient per month. An inverse relationship was observed where amount of co-pay increased as disease progressed, while costs for NHIF decreased with progression, indicating that cost-containment measures are effective.

CONCLUSIONS : Cost-containment measures help lessen the burden to the National Health Insurance fund, however, this increases the amount patients have to co-pay.