The aim of this article is to evaluate cost-effectiveness of combination therapy with SSA (somatostatin analogue) + pegvisomant compared to monotherapy with SSA in patients with acromegaly in Bulgaria. The study is prospective as data on the effectiveness (change in insulin-like growth factor 1 (IGF-1) levels (nmol/l),) among patients with acromegaly treated at “Acad. I. Penchev” Hospital. The incremental cost-effectiveness ratio (ICER) was 15 651.74 BGN for additional 1 nmol/l reduction in IGF-1, which represents the additional cost to be paid per 1 unit incremental outcome for treatment with the combination therapy. The ICER was below the upper cost-effectiveness threshold of 3 times the gross domestic product per capita according to a model developed by the World Health Organization. 30% reduction in the cost of SSA+Pegvisomant was accompanied by the most significant impact on ICER. The probability SSA+Pegvisomant therapy to be cost-effective is 61.4% when the willingness to pay threshold is 35 230.52 BGN additional cost per unit of incremental improvement. The full text of the article can be read here.