Slaveyko Djambazov

Medical University Pleven · Faculty of Pharmacy

Melanoma is a major type of skin cancer, accounting for about 5% of all cases worldwide. (1) In Bulgaria, 465 new cases were reported in 2022 making it the 16th most common cancer, contributing to 1,4% of all cancer cases. (2) Metastatic melanoma has limited treatment options, with 40% of melanoma patients not benefiting from existing first-line im...

Contact: Georgi Slavchev, slavchev@hta.bg EE64 Peripheral artery disease (PAD) reduces blood flow to the limbs and can lead to pain, numbness, tissue damage and limb loss. Primarily caused by atherosclerosis, it also increases the risk of heart attack and stroke. With a prevalence of 7.82% in Bulgaria, PAD is a significant healthcare concern. The o...

A comparative analysis was conducted, examining the HTA frameworks, regulatory structures, and key considerations in Bulgaria and North Macedonia. Relevant official guidelines, regulations, and standards issued by governmental bodies overseeing HTA processes were reviewed. (1-2) The results were consulted with key stakeholders, including government...

The integration of cancer care through Integrated Practice Unit (IPU) principles is essential for improving patient outcomes and optimizing healthcare delivery. This study focuses on implementing IPU principles, as defined by Michael Porter, for lung cancer patients, at an oncology center. An extensive evaluation involving over 90 hours of data col...

Implementing Value-Based Health Care (VBHC) in rheumatology, particularly for patients with inflammatory arthritis (IA), has the potential to significantly enhance patient outcomes relative to costs. This abstract outlines a pilot project aimed at transitioning to a VBHC system through a strategic framework involving key industry stakeholders.

INTRODUCTION: The transition to value-based healthcare requires transparent, timely, and effective communication among all stakeholders to ensure the successful implementation of new initiatives. This abstract outlines the communication strategy for the proposed pilot project implementing a Pay-for-Performance (P4P) program for diabetes management...

The integration of diagnostic oncologic biomarkers is essential for optimizing therapeutic strategies for cancer patients, maximizing therapeutic response, and minimizing treatmentassociated toxicity. This study aims to evaluate the economic and health benefits of implementing biomarker diagnostics in personalized cancer treatment in Bulgaria.

Contact: Adriana Dacheva, adriana@hta.bg EE351 Berardinelli-Seip congenital generalized lipodystrophy (CGL) is a rare disorder characterized by almost complete lipoatrophy, often leading to severe metabolic complications due to low leptin and elevated triglyceride levels. In Bulgaria, there are five confirmed CGL cases: three adult and two paediatr...

The economic model chosen for the evaluation of the medical device-radiofrequency ablation for treating chronic pain-is a cost-outcome analysis that only considers direct costs. The budget impact analysis considers the cost of the medical device and the generated saving from avoided complications. The time frame for the BIM is 3 years. Lumbar pain...

The implementation of outcome measurement and value-based healthcare (VBHC) in lung cancer treatment is crucial for enhancing patient care and clinical effectiveness. By integrating comprehensive outcome measurement systems, oncology centers can continuously monitor and improve the quality of care, aligning treatment goals with patient needs and ex...

The monetary losses due to chronic wound complications in Bulgaria are expected to reach EUR 395 000 000. Dressings have a crucial role in the management of wound exudate as one of the main factors in disease progression. There is an unmet need globally for hydrophobic dressings which can handle moderate to severe levels of exudate for prolonged pe...

Biomarkers are essential tools for determining the optimal therapeutic strategy for each cancer patient, maximizing therapeutic response, and minimizing treatment-related toxicities. Cancer cells exhibit a variety of genetic and protein variations, even within the same cancer type, impacting treatment response. Incorporating biomarker testing into...

През април 2023 г. Европейската комисия (ЕК) обявява мащабно предложение за обсъждане и преразглеждане на общотофармацевтично законодателство в Европейския съюз (ЕС). Моти-вите за актуализиране на фармацевтичната политика се основаватна поуките от пандемията COVID-19. Целта е да се осигури регу-латорна система на фармацевтичните продукти, която да...

Introduction: The aim of this analysis is to assess the cost-effectiveness of the implementation of "pay-for-performance" (P4P) program to improve the control of patients with type 2 diabetes mellitus (DM), by having an acceptable glycemic control through pharmacotherapy. Materials and methods: Patient-related health outcomes and saved direct medic...

The article discusses the development of a value-based payment model for patients with osteoarthritis (OA) in the Bulgarian healthcare system. It addresses the challenges posed by OA, emphasizing the need for long-term management strategies and the increasing demand for costly surgical treatments like arthroplasty. The proposed solution involves im...

Introduction: OCT is a noninvasive, contactless, optical method that uses infrared light to produce images of blood vessel anatomy, tissue microstructure, and stents during cardiac catheterization. Aim: This review aims to present a cost-effectiveness analysis and budget impact analysis of optical coherence tomography for imaging in patients underg...

OCT) е неинвазивен, безконтактен, оптичен метод, който използва инфрачервена светлина за произвеждане на изображения на анатомията на кръвоносни съдове, микроструктурата на тъкани и стентове по време на сърдечна катетеризация. Цел: Настоящият анализ има за цел да представи ана-лиз на разходната ефективност и анализ на бюджетното въздействие на OCT...

Натискът, който изпитват здравните системи, стана много по-видим по време на пандемията от COVID-19. Организацията, начина на финансиране, начина на заплащане на здравните дейности, пропуските в наличието на епидемиологични данни, липса на здравноинформационни системи, такива каквито са нужни, пропуските в превантивната грижа, липсата на възможност...

Introduction : National arthroplasty registries date back to 1975, when the Swedish Knee Arthroplasty Register was founded. This method of database collecting has since been employed for both patient follow-up and the creation of annual statistical reports. In Bulgaria, there is currently no state-approved software that offers these features. Aim :...

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Практическо ръководство, което помага за структуриране на научен текст, стил на научно писане, създаване на ефективни резюмета. Ръководството се спира на всеки раздел поотделно - въведение, литературен обзор, материали и методи, резултати, дискусия, заключение. Подробно обяснява как се цитират научни източници, как се изготвя рецензия, както и етич...

OBJECTIVES: The aim of this analysis is to assess the cost-effectiveness of implementing a "pay-for-performance" program to improve the control of type 2 diabetes, as measured by achieving adequate glycemic control through pharmacotherapy. METHODS: Health outcomes for patients and direct medical cost savings by the National Health Insurance Fund w...

Objectives: This abstract focuses on the evaluation of the success of a national bundle payment program for osteoarthritis (OA) in improving healthcare outcomes and controlling costs. The objectives are to outline the evaluation criteria, describe the methods for assessing program success, present the results of the evaluation, and draw conclusions...

Objectives: This paper presents a proposal to introduce a program aimed at measuring health and patient-related outcomes and implementing bundled payment for healthcare facilities to cover the complete cycle of care for patients with osteoarthritis (OA) of the hip and knee. The objective is to integrate the treatment process, incentivize improved o...

OBJECTIVES: This abstract aims to critically analyze the impact of pay-for-performance (P4P) programs on diabetes management, specifically evaluating their effectiveness in improving patient outcomes, enhancing care delivery, and addressing the challenges associated with diabetes. METHODS: A comprehensive review of the literature was conducted to i...

Objectives: Implementing a well-designed bundle payment program for osteoarthritis (OA) can have a transformative impact on care delivery, improving patient outcomes and optimizing healthcare costs. This abstract studies the designing of an effective bundle payment program for OA. The objectives are to identify key components of a successful progra...

Objectives: This abstract investigates the challenges and potential solutions associated with implementing a bundle payment program for osteoarthritis (OA) treatment. The objectives are to identify the key implementation challenges, explore potential solutions, and highlight the importance of addressing these challenges for successful program imple...

OBJECTIVES: Breast cancer (BC) accounts for 26.8% of all cancers among Bulgarian women according to the Bulgarian National Cancer Registry, 2017. In 2015, 4037 new cases were registered. The actual incidence rate was 108.1 per 100 000, the actual mortality rate-35.6 per 100 000. The five-year relative survival rate of BC in Bulgaria is 72.8%. The p...

OBJECTIVES: Intravascular ultrasound (IVUS) is an imaging modality used primarily in interventional cardiology to characterize lesion morphology, quantify plaque significance, guide stent sizing, assess stent implantation, and identify procedural complications. The primary objective of this study was to perform an economic assessment of IVUS for im...

Objectives:Migraineisanidiopathicchronicdiseasecharacterizedbyepisodesofmoderatetosevereheadache.Migraineisacommoncauseofdisabilityandlossofworkcapacity.TheanalysisaimedtoestimatethesocialcostsandhealthlossesassociatedwithMigrainepatientsinBulgaria.Currently, ICD code of Migraine is not included in the List of diseases paid by the NHIF in Bulgaria....

OBJECTIVES: Vaccination is the safest and most effective means of preventing COVID-19 and limiting the spread of the causative virus (SARS-CoV-2). Currently, more than 100 SARS-CoV-2 vaccines are in clinical trials and 24 are approved for use. Following the introduction and mass administration of vaccines approved in the European Union, there has b...

OBJECTIVES: Cervical cancer (CC) is the second most common cancer among women aged between 15 and 44 in Europe. Annually, nearly 325.3 million women over the age of 15 are at risk of developing CC. Each year approximately 61 072 women are diagnosed with cervical cancer and 25 829 die from the disease. The primary objective of this study was to eval...

OBJECTIVES: Breast cancer (BC) is one of the leading causes of death among women. Worldwide, BC is responsible for 15% of deaths caused by the disease. According to the World Agency for Research on Cancer (IARC), 1.67 million women worldwide were diagnosed with breast cancer in 2012, with 522,000 dying because of the disease. The primary objective...

Objective: This study aimed to outline the requirements and recommendations for establishing specialized stroke treatment units. Methods: The criteria for specialized stroke treatment units were categorized into seven areas and analyzed based on existing recommendations and guidelines. These areas included infrastructure, early diagnosis, diagnosti...

Objectives The objective of this study was to assess the economic burden associated with stroke by analyzing the costs of post stroke care per patient per month and per year in different countries Method: Data from multiple studies were gathered to evaluate the average costs of post stroke care Studies reporting inpatient and outpatient care costs...

Aim This abstract focuses on the use of digital outcome measurement tools to enhance clinical practice and promote patient centric care The objectives are to explore the benefits and challenges associated with implementing these tools and assess their impact on clinical decision making and patient engagement. Methods A comprehensive review of exist...

Objectives: This abstract investigates the challenges and potential solutions associated with implementing a bundle payment program for osteoarthritis (OA) treatment. The objectives are to identify the key implementation challenges, explore potential solutions, and highlight the importance of addressing these challenges for successful program imple...

Introduction: Anti-vascular endothelial growth factor (anti-VEGF) agents, such as intravitreal aflibercept, are available for the treatment of neovascular age-related macular degeneration. This manuscript aims to create a demographic profile of patients in Bulgaria and to compare the efficacy between frequent (according to label) and non-frequent (...

Introduction: Anti-vascular endothelial growth factor (anti-VEGF) agents, such as intravitreal aflibercept, are available for the treatment of neovascular age-related macular degeneration. This manuscript aims to compare the outcomes and adherence between regular application of intravitreal aflibercept (IVT-AFL) in a Bulgarian popula-tion with lite...

Въведение: Частичният (фракциониран) резерв на кръвотока (FFR) представлява съотношението на максималния миокарден кръвоток в случай на патологично променена артерия и максималния миокарден кръвоток, ако същата артерия е нормална. Цел: Целта на настоящата статия е да се направи икономическа оценка и анализ на бюджетното въздействие на медицинската...

The objective of the present paper is to assess health-related quality of life (HQOL) of oncological patients. The treatment of cancer and of other invalidating and chronic pathologies cannot neglect the patients' personal dimensions, let alone the uncertainty surrounding therapies and their effectiveness. Simultaneous consideration of all these fa...

Целта на представеното проучване е да се извършат анализ и синтез на методологията за оценка на специфичните характе- ристики на медицинските изделия в страните от ЕС с цел разработва- не на добри практики за икономическа оценка на медицинските изде- лия в България. Проведеното търсене в базите данни и анализът на идентифицираните публикации по тем...

Стратегията за подобряване на качеството на лечение на пациенти с мозъчен инсулт включва измерване на здравните резултати, базирани на ползите за пациента. Целта на изследването е да се разработи минимален стандартизиран набор от резултати и променливи за коригиране на риска, които са с най-висок приоритет за пациентите, хоспитализирани с инсулт, с...

Широко застъпено е мнението, че здравеопазването в България е сектор, който не е „на светло“, в който има много злоупотреби, но и до момента не сме видели категорични доказателства в тази посока или наказани лечебни заведения в мащабите на „злоупотребите“. Една от причините за това мнение е, че през последните 20 години средствата за здравеопазване...

Definition, measurements, instruments, methodological aspects for measurement, validity and sensitivity, modelling of longitudinal data, questionnaires, QALY and DALY calculations, types of analyses, QoL and clinical trials, sample size, reporting, meta-analysis, generic instruments

Digital therapeutics (DTx) are evidence-based therapeutic interventions that are driven by software to prevent, control, or treat a medical condition or disease. This article aims to analyze the benefits and challenges of reimbursement of digital therapies. Digital therapeutics are clinically effective in treating, controlling, and preventing a wid...

Value Based Health Care, VBHC), е подход, разработен в Harvard Business School (HBS), който изследва най-до-брите практики за реорганизиране и координиране на здравните грижи, подобряване на ефективността на процесите, прилагане на иновативни подходи за запла-щане на целия цикъл на лечение с цел постигане на резул-тати, важни за пациентите, а не ко...

Objectives: The present study investigates the determinants of oncology patients' Health-Related Quality of Life (HRQoL) in Bulgaria. Looking at some patients' characteristics, including control variables in the estimated model - demographics and the time from the disease onset, it studies the relevance of HRQoL diverse factors: some of them are r...

Трето разширено издание, с включени нови глави за оценка на здравни технологии за медицински изделия, споразумения за споделяне на риска и др.

Прилагане на общата икономическа теория към проблемите и явленията, свързани със здравето и здравеопазването

Effectiveness and economic analyses of the renal denervation for treatment of uncontrolled hypertension

Value-based healthcare (VBHC) is a service improvement approach developed at Harvard Business School (HBS) that explores the best practices for reorganizing and coordinating healthcare that aim to achieve the outcomes that are important to patients. An implementation of value-added services for patients diagnosed with age-related macular degenerati...

6 от Наредбата за условията, правилата и реда за регулиране и регистриране на цените на лекарствените продукти. Материал и методи: Извършен е задълбочен преглед на изискванията на Наредбата за условията, правилата и реда за регулиране и регистриране на цените на лекар-ствените продукти и Приложение №6 към нея от че-тирима изследователи. Тяхната зад...

This literature review presents an interest-inspiring and comprehensive illustration of the processes intended to ensure timely access to innovative medicines and devices for patients in the current cha(lle)nging environment. Product launches serve as defining moments for pharmaceutical and medical devices companies to create sustained value. Well-...

This study reviews the differences and similarities of pricing strategies. External reference pricing is still, the most commonly used approach which highlights the importance of correct drug launch sequencing to avoid price erosion

The objective of this study is to define the different methods driving the HTA recommendation in various countries in Europe.

This study aims to identify and describe the challenges regarding the implementation of performance-based managed entry agreements (MEAs) for advanced therapy medicinal products (ATMPs).

Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On March 11, 2020, the World Health Organization declared a coronavirus pandemic. Despite the intensive research in the epidemiology and prevention of the disease, there is a lack of information on speci...

Въведение Хеликоптерните спешни медицински услуги (HEMS) са неразделна част от системите на здравеопазване, особено във високоразвитите държави.(1) Основната цел на HEMS е да се „пренесе“ медицинското знание и експертиза до мястото на инцидента, да се извършат специализирани животоспасяващи интервенции извън обхвата на повечето спешни медицински ус...