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Antidiabetic Medicines Utilisation During Pre-Pandemic, Pandemic and Post-Pandemic Period of COVID-19-Data for Bulgarian Population

Mitkova Z, Stanimirova D, Manova M, Gerasimov N, Mitov K, Petrova G

Healthcare (Basel, Switzerland), 2025

Abstract

BACKGROUND: Type 2 diabetes is a chronic disease with high global prevalence and significant social and economic burden. The pandemic affected patients' diagnostics and medicines dispensing. Diabetes was among the most-affected conditions during lockdown due to the limited resources and unaffordable medicines. The impact of the pandemic on utilisation and cost has not been thoroughly studied, which inspired us to conduct the current study.

OBJECTIVES: The study explored cost dynamics, changes in antidiabetic medicines utilisation, and public expenditure of pharmacotherapy in three periods: pre-pandemic (2018-2019), during the pandemic (2020-2021), and post-pandemic (2022-2023).

METHODS: It is a retrospective, observational, macroeconomic analysis. Reimbursed cost and utilisation were analysed as a crude sum and as indexes of the average value.

RESULTS: The result shows that five new INNs have been included in the Positive Medicines List (PML), two of these being fixed dose combinations (FDCs). During the pandemic, a slow tendency of increase of the crude sum of public expenditure was observed, followed by a sharp increase in the post-pandemic period. The public spending increased more than twice, and we found a 30,018,982 Euro growth. The highest public spending is found for dapagliflozine in post-pandemic vs. pandemic period (index = 1.67), as well as empagliflozin/metformin and dapagliflozine in pandemic vs. pre-pandemic period (index = 0.21). Total utilisation increases…

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