The Bulgarian experience: Health technology assessment as a decision science

Abstract

This review article explores the role of Health Technology Assessment (HTA) as a multidisciplinary decision science that systematically evaluates the medical, economic, social, and ethical aspects of healthcare technologies. Health Technology Assessment supports policymakers, clinicians, and healthcare providers by ensuring that interventions are not only clinically effective but also cost-efficient and aligned with patient needs. In Bulgaria, HTA has become a critical tool for resource allocation, transparency, and the sustainability of the healthcare system.

The paper highlights the advantages of HTA, including transparency in decision-making, strategic resource planning, facilitation of risk-sharing agreements, incorporation of patient perspectives, and promotion of innovation. By aligning national policies with international standards, HTA strengthens evidence-based practices and fosters collaboration among diverse stakeholders, such as government agencies, payers, providers, patient groups, and industry.

Several case studies from Bulgaria illustrate HTA’s impact. For oncology, biomarker testing demonstrates significant health benefits (+21,000 life years, +16,600 quality-adjusted life years (QALYs)) and economic gains (€76 million GDP contribution). Analyses of disease burdens such as neovascular age-related macular degeneration (nAMD), peripheral artery disease (PAD), lipodystrophy, and atopic dermatitis quantify the direct and indirect costs, emphasizing the need for improved management and policy prioritization. Similarly, projects on sarcoma care expose systemic gaps, underscoring the importance of centralized care and multidisciplinary approaches.

Innovative policy models, such as pay-for-performance (P4P) in diabetes care, illustrate how financial incentives linked to treatment outcomes can improve patient health while generating long-term savings. Evaluations of medical devices, including wound care systems, show cost-effectiveness in reducing amputations and relapses. National screening programs for breast, cervical, and colorectal cancers highlight how early detection significantly improves QALYs while reducing long-term costs.

The analysis also demonstrates the substantial benefits of high-cost innovative treatments for oncology, autoimmune disorders, diabetes, schizophrenia, asthma, hepatitis C, and rare diseases. Collectively, these therapies contribute over 1.24 million QALYs and €6.55 billion (7.13% of GDP) to the Bulgarian economy, proving their dual health and economic value.

In conclusion, the Bulgarian experience with HTA exemplifies its transformative role in shaping evidence-based, sustainable, and patient-centred healthcare policies, reinforcing its importance as a cornerstone of modern health systems.