Budget cap and pay-back model to control spending on medicines: A case study of Bulgaria.

Central and Eastern European countries (CEEC) have among the highest rates of increase in healthcare expenditure. External reference pricing, generics and biologics price capping, regressive scale for price setting, health technology assessment (HTA), and positive drug lists for reimbursed medicines are among the variety of implemented cost-containment measures aimed at reducing and controlling the rising cost for pharmaceuticals. The aim of our study was to analyze the influence of a recently introduced measure in Bulgaria-budget capping in terms of overall budget expenditure. A secondary goal was to analyze current and extrapolate future trends in the healthcare and pharmaceutical budget based on data from 2016 to 2021. The study is a retrospective, observational and prognostic, macroeconomic analysis of the National Health Insurance Fund's (NHIF) budget before (2016-2018) and after (2019-2021) the introduction of the new budget cap model. Subgroups analysis for each of the three new budget groups of medicines (group A: medicines for outpatient treatment, prescribed after approval by a committee of 3 specialists; group B: all other medicines out of group A; and group C: oncology and life-saving medicines out of group A) was also performed, and the data were extrapolated for the next 3 years. The Kruskal-Wallis test was applied to establish statistically significant differences between the groups. During 2016-2021, healthcare services and pharmaceutical spending increased permanently, observing a growth of 82 and 80%, respectively. The overall healthcare budget increased from European €1.8 billion to 3.3 billion. The subgroup analysis showed a similar trend for all three groups, with similar growth between them. The highest spending was observed in group C, which outpaced the others mainly due to the particular antineoplastic (chemotherapy) medicines included in it. The rising overall healthcare cost in Bulgaria (from European €1.8 billion to 3.3 billion) reveals that implementation of a mechanism for budget predictability and sustainability is needed. The introduced budget cap is a relatively effective measure, but the high level of overspending and pay-back amount (from European €34 billion to 59 billion during 2019-2021) reveals that the market environmental risk factors are not well foreseen and practically implemented.

Evaluation of the quality of life after implantation of light or standard polypropylene hernia meshes.

Abstract.

Investigation of mechanical compatibility of hernia meshes and human abdominal fascia.

OBJECTIVE: Understanding the biomechanical properties of hernia meshes is essential in facilitating their selection. The aim of this study was to evaluate the mechanical compatibility of hernia meshes and human abdominal fascia and assess their applicability in hernia repair. METHODS: Uniaxial tensile tests were performed. A total of eight hernia meshes were tested - three standard meshes (Surgimesh®, Surgipro™, TecnoMesh®) and five light-weight meshes (Optilene®, TiO2Mesh™, Parietex™, Vypro™ II, Ultrapro™). RESULTS: The secant modulus at 5% strain and the level of orthotropy (the ratio between tensile stress in the longitudinal and the transversal direction) at 5% strain were calculated from the stress-stretch ratio curves. The impact of pore size and thickness on the elastic properties of these meshes was determined. The relationships between density and elasticity as well as between elasticity and the strain developed at 16 N/cm load were presented. The resulting mechanical properties of meshes were compared to the elasticity, orthotropy and deformability of human abdominal fascia. CONCLUSIONS: Vypro™ II and Parietex™ brands display properties similar to those of fascia in both directions. The TiO2Mesh™ and Ultrapro™ display deformability close to the deformability at 16 N/cm of the fascia transversalis. Only the Vypro™ II brand's orthotropy is similar to that of fascia.

Clinical characteristics, treatment patterns, and socio-economic burden of COPD in Bulgaria.

BACKGROUND: While the impact of COPD in Western-Europe is known, data from Eastern-Europe is scarce. This study aimed to evaluate clinical characteristics, treatment patterns, and the socio-economic burden of COPD in Eastern-Europe, taking Bulgaria as a reference case. METHODS: A representative sample of Bulgarian patients with COPD was randomly chosen by pulmonologists, based on the following inclusion criteria: COPD diagnosis with at least 1 year of living with COPD, ≥40 years of age, and use of COPD medication. Patient characteristics, treatment, quality-of-life, healthcare resource use, and costs were systematically assessed. RESULTS: A total of 426 COPD patients were enrolled. Approximately 69% were male, 40% had occupational risk factors, 45% had severe and 11% had very severe COPD. Mean CAT scores were 13.80 (GOLD A), 21.80 (GOLD B), 17.35 (GOLD C), and 26.70 (GOLD D). Annual per-patient costs of healthcare utilization were €579. Yearly pharmacotherapy costs were €693. Indirect costs (reduced and lost work productivity) outnumbered direct costs three times. CONCLUSIONS: Bulgaria has relatively high percentages of (very) severe COPD patients, resulting in considerable socio-economic burden. High smoking rates, occupational risk factors, air pollution, and a differential health system may be related to this finding. Eastern-European COPD strategies should focus on prevention, risk-factor awareness, and early detection.