Abstract: The hypertension is one of the major socially significant diseases with an extremely high prevalence in Bulgaria. The costs due to hypertension vary significantly between European countries due to differences in healthcare systems and income levels. The aim of the current study is to analyse the changes in public spending on the treatment of hypertension with two main groups of medicinal products ACE-inhibitors and sartans. A retrospective review of the annual NHIF expenditure for the period 2016-2021 was performed. The differences in cost of the individual products was extracted through the National Council of Pricing and Reimbursement website. The results show that public expenditure decreased over the observed period. Public spending on sartanas is lower in 2019 compared to those in 2016 by 278218 BGN. The NHIF expenditure on ACE inhibitors decreased by 943580.46 in 2021 compared to 2016. The reference price per defined daily dose (DDD) remains unchanged for the majority of considered products or decreases as a result of external reference pricing. Other factors also influencing changes in cost and the  reference price per DDD are therapeutic competition, the increasing utilization of fixed dose combinations in cardiology, and the large number of generics entering the market.

Keywords: public expenditure, sartans, ACE inhibitors, reference price per DDD

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