FfW Bulgarian report (English language) - Fit for Work Europe

RA in Bulgaria who receive biologic treatments is lower than in most European countries
with proportions ranging from less than 1 per cent of patients (Kolbelt and Kastaeng, 2009)
to 1.8 per cent (Orlewska, Ancuta, Anic, Codrenau, Damjanov et al., 2011).This is very low
indeed compared with the European treatment average of 9-10 per cent, however it may
reflect the state of Bulgaria’s GDP. According to Kobelt and Kastaeng the use of biologics for
RA corresponds to the wealth of the country where countries with a lower GDP are less likely
to afford the high costs associated with this type of treatment. Indeed, the affordability index
for biologic treatment in Bulgaria is the lowest among all the countries studied (Kolbelt and
Kastaeng, 2009).
In addition, the Bulgarian ‘Drug Act’ (2007) does not appear to take into consideration the quality
of life and work outcomes when evaluating the benefits of drugs recommended for treatment. It
is important that the cost-effectiveness analysis of treatment recognises the need to ‘spend to
save’, as often the savings associated delayed benefits of certain treatment, such as facilitated
return to work and longer working life outweigh the immediate cost of the intervention.
Due to insufficient number of consultants in Bulgaria and poor diagnosis treatment is delayed
for some RA patients who would benefit from anti-TNF drug therapies in order to prevent
incapacity. 38 Where structural damage of joints has already occurred, the patients may require
surgery to replace joints; however, the high costs associated with the procedure may hinder
access to treatment. For many who have lost their jobs due to incapacity and have no funds
to support themselves, an intervention that would support to return them to work is largely
unaffordable. 39
Medical interventions in the form of drug therapy to control inflammation and disease
progression, and surgery to redress structural damage are only part of managing the care of
RA patients. Other important elements include patient education and empowerment, practical
self-management to help deal with symptoms and specialist support to help live with the disease
and its consequences. The effective management of RA has to involve not only the clinical
team (including GPs, consultant rheumatologists, physiotherapists, occupational therapists,
chiropodists, podiatrists, pharmacists, primary care nurses and orthopaedic surgeons), but the
participation of the patient and, ideally, their employers and relevant patient groups. Patient
organisations exist in Bulgaria but they rely almost entirely on volunteers (often with the
rheumatic conditions themselves) and some financial support from pharmaceutical companies,
however, due to limited resources they are restricted by what impact they could have. 40 One
38 Expert interview
39 Expert interview
40 Expert interview
Interventions
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