Bulgaria is among the European Union (EU) countries with the highest burden of cervical cancers and life expectancy below the EU average. The majority of cervical cancer cases (more than 95%) are caused by the human papillomavirus (HPV). The aim of this retrospective, cost of illness study is to identify direct healthcare costs of cervical cancer in Bulgaria from the payer perspective and to calculate indirect costs and the associated years of life lost. Costs data were sourced from the National Health Insurance Fund from January 2018 to December 2020. Years of life lost were calculated based on the country and gender-specific life expectancy. Indirect costs due to productivity loss were calculated using the human capital approach. The total treatment costs for 3540 patients with cervical cancer are EUR 5,743,657 (2018), EUR 6,377,508 (2019), and EUR 6,751,182 (2020). The costs associated with drug acquisition and administration accounted for the majority (63%) of total healthcare costs followed by hospital management costs (14%). An estimated total of 20,446 years of life were lost due to cervical cancer for the period 2018–2020. The costs of productivity losses are estimated at EUR 7,578,014. Our study showed that the economic burden of cervical cancer in Bulgaria is substantial. Focus on cervical cancer prevention via vaccination against the human papillomavirus, timely screening, early diagnosis, and higher vaccine coverage rates could reduce its economic burden in Bulgaria.

Objectives : Patient-centric healthcare ecosystems prioritize personalized diagnostics and treatments based on high-quality evidence regarding health technologies. Pharmacotherapeutic guidelines are essential for providing evidence-based recommendations, enhancing patient safety, and aligning healthcare policies with early detection and rational drug use. Methods : This study compares the Bulgarian pharmacotherapeutic guideline on breast cancer with the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), and European Society for Medical Oncology (ESMO) guidelines using the Population, Intervention, Comparison, and Outcome (PICO) methodology, assessing alignment in screening, pharmacotherapy, follow-up, outcomes, and shared decision-making. Results : The results show that Bulgaria has a unified set of guidelines for tumor locations but lacks specific recommendations for screening and shared decision-making. While these guidelines align closely with international standards for breast cancer treatment, they do not offer guidance on follow-up, outcomes, or genomic profiling. Importantly, they incorporate new therapies before these are added to the Positive Drug List, thereby influencing regulatory decisions and patient access to treatments. Conclusion : The Bulgarian pharmacotherapeutic guideline on breast cancer aligns with international standards but could be improved with respect to screening, early detection, therapy adherence, and shared decision-making. A structured classification for levels of evidence would also enhance the guidelines.

Purpose: This study aimed to analyze the epidemiological, clinical, and therapeutic characteristics of patients with pulmonary arterial hypertension (PAH) treated at a major reference center in Bulgaria and to assess treatment patterns, patient compliance, and overall survival. Principal Results: The epidemiological data revealed that 69.5% of the patients were female, with a mean age of 52 years. The majority of patients were diagnosed at advanced stages of PAH, with 92.1% classified as World Health Organization Functional Class III. Monotherapy was the most common treatment regimen, used by 61.4% of patients, despite advanced disease. Patients who adhered to treatment demonstrated significantly longer overall survival (78.9 months) compared to those lost to follow‐up (50.8 months). The study also identified a 31% rate of noncompliance, with patients missing follow‐up visits and becoming ineligible for further therapy. Major Conclusions: The findings highlight the need for earlier diagnosis and more aggressive treatment strategies, as monotherapy appears insufficient for optimal outcomes in advanced PAH. Establishing a national PAH registry and increasing disease awareness could facilitate earlier interventions and improve patient outcomes in Bulgaria.