The inflammatory joint diseases are characterized by high prevalence rates and significant burdens in both Bulgaria and Serbia. Regional differences in pricing policy might influence access to therapy. The goal of our study is to compare and analyze the prices, public spending, and utilization of biological disease modifying drugs for the treatment of antirheumatic diseases (bDMARDs) in Bulgaria and Serbia. It is macro costing, cross-country comparative analysis for the period 2016–2020, which is based on a retrospective review of officially published information about prices, public expenditures, and utilization. The reference prices and public expenditures are retrospectively extracted from the national regulatory bodies. Utilization is calculated as the defined daily dose (DDD)/1000 inh/day. Reference prices per DDD decline in both countries during the observed period, mostly visible for bDMARDs with biosimilar alternatives, mainly infliximab, adalimumab, and etanercept. The price differences are statistically significant for 3 International Nonproprietary Names (INNs): infliximab, golimumab, and secukinumab. Public spending and utilization are almost twice higher in Bulgaria. The medicine with the highest utilization in Serbia is infliximab, while in Bulgaria is adalimumab. Pricing policies and new molecules entrance influence utilization and expenditures for bDMARDs positively but improve patients' access. Utilization, access to new molecules and expenditures are higher in Bulgaria, but prices for most bDMARDs are lower in Serbia. Comparative price analysis supports information about the access to medicines and enlightens pricing policies. Further studies are needed in order to examine all the factors affecting medicine prices and public spending.
Mitkova et al. (Tue,) studied this question.