A cross-sectional study was carried out in 2016 in the research project No 4/2016. We selected 98 patients aged 40-89 and diagnosed with hypertension. The patients were admitted to Cardiology Clinic One of the University Hospital in Pleven. The study aimed to measure and compare direct and indirect costs of hypertensive patients aged 40-89 years, who were treated with lisinopril and perindopril. We estimated the total and average costs of 50 (51.0%) patients treated with lisinopril and 48 (49.0%) treated with perindopril. Males were 46.4%, and the mean age of the sample was 65.9.0±11.2 years. Data were processed by Statistical Package for Social Science version 19.0 (SPSS.v.19.0). Total costs exceeded amount reimbursed for the clinical path (BGN 420.00) in 64.6% of the patients treated with perindopril and 48.0% of the patients treated with lisinopril. We found that treatment costs within 6-months after discharge were BGN 673.82 in patients treated with lisinopril, as compared to BGN 171.92 reimbursed by the National Health Insurance Fund (NHIF), and BGN 781.18 for those treated with perindopril, compared to BGN 216.33 reimbursed by NHIF. The NHIF reimbursement rate for antihypertensive treatment is insufficient to cover all direct costs. Increased hospital costs and out-of-pocket payments present a significant restriction on access to treatment for arterial hypertension.
1. Ordinance No 04-07-1 of Mar, 29, 2016 for correction and in addition to Ordinance N0 04-24-1: Published by Ministry of Health. State Gazette. 2016 Mar, 25.
2. National Council on Prices and Reimbursement of Medical Products. Positive Drug List 2017 [Internet]. Sofia 2017 [cited 2017 June 16]. Available from: http://www.ncpr.bg/bg/
3. Ministry of Health. [National Framework Contract between NHIF and BMA – 2015]. State Gazette Issue 25 as of March 31, 2016. Bulgarian
4. Government Decree No 193 of Aug, 28, 2012. Published by Council of Minister of the Republic in Bulgaria. State Gazette.2012 Sept, 4
5. Government Decree No 312 of Dec, 27, 2013 for correction and in addition to Government Decree N0 193 of Aug, 28, 2012. Published by Council of Minister of the Republic in Bulgaria. State Gazette. 2014 Jan, 7.
6. Drummond M, O’ Brien BJ, Stoddart G, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. 3rd ed. Oxford: University Press, 2005.
7. Center of Emergency Medical Care – Pleven. [Specification of ambulance]. p. 3. Bulgarian.
8. Ministry of Health of the Republic of Bulgaria. [Concept “Objective for Health 2020”], Sofia; 2015. Bulgarian
9. [Payment methods of health services in hospital care.] Published by Council of Minister of the Republic in Bulgaria. State Gazette, 2015 Mar, 20. Bulgarian.
10. Hansson L, Lloyd A, Anderson P, Kopp Z. Excess morbidity and cost of failure to achieve targets for blood pressure control in Europe. Blood Press. 2002;11(1):35-45.
11. Bulgarian Society of Internal Medicine. [National Association of general practitioners in Bulgaria, Bulgarian Hypertension league. Guideline of the Management of the Arterial hypertension for general practitioners]. Sofia: National Association of general practitioners in Bulgaria; 2007. Bulgarian
12. Marinov L. [Arterial hypertension and salt intake]. Science Cardiology 2009;3:100-102. Bulgarian
13. Moran A, Odden M, Thanataveerat A, Tzong K, Rasmussen P, et al. Cost-effectiveness of Hypertension Therapy According to 2014 Guidelines. N Engl J Med. 2015;372(17):1677.
14. Naser N, Dzubur A, Durak A, Kulic M, Naser N. Blood Pressure Control in Hypertensive Patients, Cardiovascular Risk Profile and the Prevalence of Masked Uncontrolled Hypertension (MUCH). Med Arch. 2016;70(4):274-9.
15. Torbova S, Gocheva N, Sirakova V, Tarnovska R, Donova T, Vlahov V. [Consensus of monotherapy and combination therapy of patients with Arterial Hypertension in Bulgaria]. Bulgarian Cardiology 2005;5(11), 1-31. Bulgarian.
16. Georgiev B, Genov A, Baitcheva V, Kostova E. [Combination therapy in essential hypertension: contemporary approach to combine calcium antagonists and beta-blockers]. Science Cardiology 2014;15(5):231-239. Bulgarian.
17. Vekov T. [Stimulation of generic drugs prescription – the shortest way to cut public and personal costs for medical products]. General medicine journal 2009;11(3):14-16. Bulgarian.
18. Raev D, Barkalova D. Initial antihypertensive therapy in Bulgaria. A National prospective, observational study (BP-Initial Therapy-BG study). Journal of Hypertension. 2015;33 Suppl 1.
19. Vekov T. [Analysis of reimbursement expenditures of the National Health Insurance Fund for medical products for home therapy]. General medicine journal 2012;14(3):23-29. Bulgarian.
20. Gocheva N. [Initial therapy of arterial hypertension by combined drug with low dosage]. Science Cardiology 2005; 3:100-104. Bulgarian.
21. Bian B, Kelton C, Guo J, Wigle P. ACE Inhibitor and ARB Utilization and Expenditures in the Medicaid Fee-For-Service Program from 1991 to 2008. J Manag Care Pharm. 2010;16(9):671-9.
22. Consumer Report Health. Using ACE inhibitors to treat: High Blood Pressure and Hearth Disease – Companying Effectiveness, Safety and Price, 19 p.
23. Lee P, Robin K, Chan J, Chang S, Lee SC, Tomlinson B. A prescription survey in a hospital hypertension outpatient clinic. Br J Clin Pharmacol. 1997;44:577-2.
24. Ivanova A, Petrova G. Hypertension and common complications – analysis of the ambulatory treatment cost. Cent Eur J Public Health. 2009;17(4):223-0.
25. Moreira GC, Cipullo JP, Martin JF. Evaluation of the awareness, control and cost-effectiveness of hypertension treatment in a Brazilian city: populational study. J Hypertens. 2009;27:1900-7.
26. Dias da Costa JS, Fuchs SC, Olinto MT. Cost-effectiveness of hypertension treatment: a population-based study. Sao Paulo Med J. 2002;120(4):100-4.
27. Krzysztoszek J, Koligat D, Ratajczak P, Bryl W, Cymerys M, Hoffmann K, et al. Piotr Ratajczak1, Wieslaw. Economic aspects of hypertension treatment in Poland. Arch Med Sci. 2014;10(3):607-7.
28. Heidenreich PA, Davis BR, Cutler JA. Cost-effectiveness of chlorthalidone, amlodipine, and lisinopril as first-step treatment for patients with hypertension: an analysis of theAntihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Gen Intern Med. 2008; 23(5):509-6.
29. Azarisman SMS, Aszrin A, Sahimi M, Ngow HA, Marzuki AO, Jamalludin AR, et al. Evaluation of antihypertensive drug utilization and cost in Hospital Tengku Ampuan Afzan, Kuantan. IMJ. 2009;8(2):29-35.
30. Small RE, Freeman-Arnold SB, Goode JV, Pyles MA. Evaluation of the total cost of treating elderly hypertensive patients with ACE inhibitors: a comparison of older and newer agents. Pharmacotherapy. 1997;17(5):1011-6.
31. Rizzo JA, Abbott TA, III, Pashko S. Labour productivity effects of prescribed medicines for chronically ill workers. Health Econ. 1996;5(3):249-5.
32. National Institute for Health and Clinical Excellence. Hypertension: Cost Report – Implementing NICE Guidance 2011. London: NICE Midcity Place; 2011.