Abstract

The COVID-19 pandemic expansion in Bulgaria imposed a significant burden on population status and disease diagnostics, control, and treatment. The goal of our study is to analyze the impact of the COVID-19 pandemic on utilization of antidepressants in the outpatient treatment of depression and public spending on their reimbursement. The study is a cross-sectional, retrospective, observational, macroeconomic analysis of National Health Insurance Fund (NHIF) expenditures of antidepressants, reference price per defined daily dose (DDD), and utilization. The results reveal that the costs and reference value per DDD decreased or remained almost the same during 2019– 2020. The utilization increased slightly for six international nonproprietary names (INNs) and decreased for four of them. Statistical analysis confirms that there are no significant differences. The highest utilization rate found is for escitalopram (both 2019 and 2020), followed by paroxetine and venlafaxine. The COVID- 19 pandemic and social isolation lead to worsening of mental health and require health system reorganization to ensure the treatment of patients with chronic diseases. The measures implemented in Bulgaria at the beginning of the pandemic led to a stable level of medicine utilization and outpatient treatment of depression as well as a similar rate of NHIF expenditure compared with those from the previous year.

Key words: COVID-19 pandemic, depression, costs, outpatient treatment, utilization, Bulgaria