OBJECTIVES: To analyze the annual pharmacotherapy cost for acromegaly patients paid by National Health Insurance Fund (NHIF) in Bulgaria and to predict their future cost changes in the next 3 years.

METHODS: A retrospective analysis of the reimbursed medicinal products for acromegaly for the period 2015-2017 was performed. The direct pharmacotherapy costs paid by NHIF for every International Nonproprietary Name (INN) for acromegaly were collected and extrapolated for the next 3 years applying exponential and linear functions. The Compound Annual Growth Rate (CAGR) for each medicinal product for acromegaly paid by NHIF was calculated. The top-down approach was applied in order to reveal the average reimbursed cost per Bulgarian acromegaly patient.

RESULTS: According to the official NHIF sales data, the number of ambulatory patients with acromegaly in Bulgaria is about 180 in 2016 and 160 in 2017. Pegvisomant, octreotide, pasireotide and bromocriptine for acromegaly patients (International Statistical Classification of Diseases and Related Health Problems 10th Revision ICD10-code: E22.0) are the medicines included in the Bulgarian Positive Drug List Annex 1. The annual spending on pegvisomant and pasireotide has been increasing for the observed period with annual growth rates (CAGR) of 7% and 66%, respectively. The cost for somatostatin analog octreotide decreased in 2017 with a negative CAGR level of -4%, probably due to the parallel medicines export. The average annual per-patient cost of acromegaly paid by the National Health Insurance Fund in the last 2 years is around 11 600 euro (SD=174.65).

CONCLUSIONS: The average annual pharmacotherapy cost for acromegaly in Bulgaria is about 2 million euro or about 0.4% of the total pharmaceutical expenditures costs paid by NHIF and the expectations are for slightly cost increasing in the near future.