Deep brain stimulation as a form of treatment for advanced Parkinson's disease was completely free from 2019, and from January 1, 2024, it costs BGN 6,000 for patients. The decision of the Health Insurance Fund also affects those who have to replace the battery of an already installed device. The generator device delivers a high-frequency current via electrodes to the brain, which affects certain centers and significantly reduces the unpleasant symptoms of Parkinson's. Prof. Dr. Krasimir Minkin, neurosurgeon specialist at UMBAL “St. Ivan Rilski”, as it was his team that introduced Deep Brain Stimulation (DMS) in Bulgaria in 2013.
- Professor Minkin, we recently celebrated the international day for the fight against Parkinson's disease, and in Bulgaria, instead of boasting about the successes, we are talking about the fact that the treatment is becoming more expensive. Why?
- We have a lot to brag about in Bulgaria when we talk about the treatment of Parkinson's, because, fortunately for us, Bulgaria is one of the most developed countries in the treatment of this disease in the world and we have access to the three main methods of modern treatment in patients with advanced Parkinson's disease - we are talking about Deep brain stimulation, infusion with apomorphine and levodopacarbidopa intestinal gel. These are still expensive treatments, and each of these three treatments was free until January 1, 2024. From 2019 to January 1, 2024, all three methods were free. Now, unfortunately, only DMS from the beginning of 2024 has dropped from the list, in which the treatment is 100% reimbursed by the NHIF, and an additional payment of BGN 6,000 has to be made. However, it should be taken into account that nearly 90% of the cost of the implant – the vast majority continues to be paid by the NHIF.
- How many patients does this change affect and why did this surcharge come about?
- The surcharge arose from the fact of an increase in the prices of medical devices. There is an increase in almost all products on the market, as well as in DMS. The price went up by BGN 6,000. It went from BGN 40,000 to BGN 46,000 for non-rechargeable batteries and BGN 60,000 to BGN 66,000 for rechargeable batteries. This is the reason why the NHIF decided that these increases should be paid for by patients. In total, this affects 20 patients undergoing primary implantation and another 10 who will need to have the battery replaced. In Eche, we have many patients who were implanted in the period 2019 - 2024, and some of them need to replace the battery.
- So at the moment patients are faced with a dilemma. Is that how we understand…
? - For a part of the patients, this 6,000 BGN is not a problem, but there are also those who refused surgical treatment because they cannot afford the amount. From 2019 to 2024, patients did not pay a penny for either the implant or the operation.
- But now they have to choose…
- I would not say that this is a dilemma, but rather a discrimination of the method. Because DMS is the only one of the three methods where we have an additional payment. The other two methods, which are not as effective and very often have more complications, continue to be reimbursed at 100%. It's just that now the patients who chose DMS are put at a disadvantage compared to those who trusted the other two methods.
- How widespread is Parkinson's disease in Bulgaria?
- In our country, we have about 12,000 patients with Parkinson's disease, but we do not have statistics that are based on accurate data. We have 1,000 - 1,200 patients who have advanced Parkinson's disease and could potentially use any of the three methods I talked about. In order to apply a treatment method for Parkinson's, the patient must meet strictly defined criteria, i.e. to have a not too advanced disease - to be confined to bed, but also to have advanced Parkinson's disease, when the drugs no longer affect them sufficiently. Patients who receive Deep Brain Stimulation are: between the ages of 5 and 15 from the beginning of the disease .
- Is this absolutely the most modern treatment available both in our country and around the world?
- Yes. It has been applied in our country since 2013. We already have about 120 patients who have implanted DMS and in Bulgaria we belong to the large centers for this treatment in Europe. We already have extensive experience with the intervention to such an extent that we can call it routine. Of these 120 patients, we have had no serious complication so far. I will repeat that DMS is a method that is completely modern, was fully reimbursed by the NHIF, and instead of moving forward, we have taken a step back, given that co-payment is required. This definitely discriminates against poorer patients.
- If we could make a summary, make an analysis and comparison for all the years during which patients undergo this intervention, what is its effect?
- Very impressive. For over 90% of operated patients - like any method, it is not 100% effective, because we cannot talk about a cure, but in 90% of patients we manage to turn back the clock of the disease by 5-10 years, improving the quality of people's lives. Such are the statistics around the world and in our country. This is not just our achievement. As our achievement, I would define the very introduction of this method, because in 2013 it was very difficult and for six years – until 2019, we struggled to get paid by the NHS. Our first 30 patients had to pay the cost of the entire implant. There were also patients who had donation campaigns because they could not afford the amount. It was a very big struggle in the early years. And now it has reached the other pole. Until recently, we told the patient that he would be operated on for BGN 0, but now we are taking a step back. But rather, I think that this is a mistake by the NHIF and a lack of dialogue with us. I think that a solution to this problem will soon be found, since it is not a question of some gigantic burden on the budget of the NHIF, which is over BGN 8 billion.