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Professor Borislava (Boby) Mihaylova, DPhil

Borislava (Boby)

Chair in Health Economics

Telephone: +44 0207 882 3863


Borislava Mihaylova is a Professor of Health Economics at the Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London and leads the work of the health economics team at the Centre.

Borislava has wide ranging interests in health economic evaluation and health policy analyses with particular focus on cost-effectiveness analysis alongside clinical trials, evidence synthesis, heterogeneity in cost-effectiveness and statistical and epidemiologic methods in these areas. Her work on effectiveness and cost-effectiveness of statins for cardiovascular disease prevention has been highly influential in informing treatment recommendations for people at different vascular disease risk. 

Professor Mihaylova teaches at postgraduate, graduate and undergraduate levels and supervises students in her research areas.


Borislava was appointed to the Chair in Health Economics at the Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London in January 2018.  She also holds a part-time position of Associate Professor and Senior Health Economist at the University of Oxford's Health Economics Research Centre (HERC).

While studying BSc/MSc in Computer Sciences and Financial Technologies at the Technical University of Sofia, Bulgaria (1990-95), Borislava became involved in the development of the National Health Insurance system in Bulgaria. In 1993-9 she worked at the National Centre of Public Health and National Health Insurance Fund, Bulgaria on the design and implementation of case-mix payment methods for hospital care in Bulgaria. After completing her MSc in Health Economics at the University of York, UK (2000), she took a research post at the University of Southampton working on the health economic analyses of NHS Direct, the NHS out-of-hours system at the time, and growth hormone treatment in children and adults. In 2001-5 she completed a DPhil in Health Economics studying the cost-effectiveness of simvastatin in people at different cardiovascular disease risk in the 20,000-large Heart Protection Study guided by Professors Andrew Briggs, Rory Collins, Alastair Gray, Jane Armitage and Sarah Parish and supported by a NHS Training Fellowship. She continued her research work at the University of Oxford becoming University Research Lecturer in 2011 and Associate Professor in 2015.

Prof Mihaylova is a member of the NIHR Programme Grants for Applied Research (PGfAR) subpanel since June 2016.


MSc in Global Health Science and Epidemiology, University of Oxford

  • Health Economics module: lecturer, examiner
  • MSc dissertation: supervisor, examiner 

DPhil in Population Health, University of Oxford

  • Supervisor


Research Interests:

Professor Mihaylova’s research programme focuses on studying economic aspects of chronic diseases (eg,  respiratory health and asthma, mental health, cardiovascular, chronic kidney disease and diabetes) and interventions and comprises studies of the impact of diseases and interventions on morbidity, mortality, health-related quality of life and healthcare costs; development of disease models to evaluate long-term effects of diseases and interventions, cost-effectiveness analyses of healthcare interventions and studies of socio-economic determinants of health. She leads the development of the economic analyses of policies and treatments studied a number of large randomised (SCENE, SHARP, THRIVE, REVEAL and ACST-2) and non-randomised (ULEZ) controlled studies, and in the individual participant data meta-analysis of statin trials (Cholesterol Treatment Collaboration). Her goal is to generate evidence that reliably informs national and international health policy and improves population health.

Research Group Members and URL pages

Dr Vladislav Berdunov, Health Economist

Dr Natalia Hounsome, Asthma UK Centre for Applied Research Lecturer in Health Economics

Chris Roukas, Health Economist



Key Publications:

Schlackow I, Kent S, Herrington W, Emberson J, Haynes R, Reith C, Wanner C, Fellström B, Gray A, Landray MJ, Baigent C, Mihaylova B on behalf of the SHARP Collaborative Group. A policy model of cardiovascular disease in moderate-to-advanced chronic kidney disease. Heart 2017;103:1880-1890.

Kent S, Green J, Reeves G, Beral V, Gray A, Jebb SA, Cairns BJ*, Mihaylova B*, on behalf of the Million Women Study collaborators. Hospital costs in relation to body mass index in 1.1 million women in England: a prospective cohort study. Lancet Public Health. 2017. 2: e214–22.

Cholesterol Treatment Trialists’ (CTT) Collaboration (Writing committee: W Herrington*, J Emberson*, B Mihaylova*, L Blackwell, C Reith, M D Solbu, P B Mark, B Fellström, A G Jardine, C Wanner, H Holdaas, J Fulcher, R Haynes, M J Landray, A Keech, J Simes, R Collins, C Baigent). Impact of renal function on the effects of reducing LDL cholesterol with statin-based regimens: meta-analysis of individual data from 28 randomised trials. Lancet Diabetes and Endocrinology. 2016; 4: 829–39.

Kent S, Haynes R, Hopewell J, Parish S, Gray A, Landray M J, Collins R, Armitage J, Mihaylova B on behalf of the HPS2-THRIVE Collaborative Group. The Effects of Vascular and Nonvascular Adverse Events and of Extended-Release Niacin with Laropiprant on Health and Healthcare Costs. Circulation: Cardiovascular Quality and Outcomes. 2016; 9:348-354.

Mihaylova B, Schlackow I, Herrington W, Lozano-Kühne J, Kent S, Emberson J, Reith C, Haynes R, Cass A, Craig J, Gray A, Collins R, Landray M, Baigent C. Cost-effectiveness of Simvastatin Plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP).  American Journal of Kidney Diseases. 2016; 67(4): 576-584.

Cholesterol Treatment Trialists’ (CTT) Collaborators (Writing Committee: Mihaylova B, Emberson J, Blackwell L, Keech A, Simes J, Barnes E H, Voysey M, Gray A, Collins R, and Baigent C). The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012;380(9841):581-90.

Mihaylova B, Briggs A, O'Hagan A, Thompson SG. Review of statistical methods for analysing healthcare resources and costs. Health Economics 2011;20(8):897-916.

Mihaylova B, Briggs A, Armitage J, Parish S, Gray A, Collins R on behalf of the Heart Protection Study Collaborative Group. Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20,536 people. BMJ 2006;333:1145-8.

Mihaylova B, Briggs A, Armitage J, Parish S, Gray A, Collins R on behalf of the Heart Protection Study Collaborative Group. Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: economic analysis of a randomised trial in 20,536 individuals. Lancet 2005;365:1779-85.


Further publications:

Morton RL, Schlackow I, Gray A, Emberson J, Herrington W, Staplin N, Reith C, Howard K, Landray MJ, Cass A, Baigent C, Mihaylova B, on behalf of the SHARP Collaborative Group, Impact of chronic kidney disease on household income, Kidney International Reports (2018), doi: 10.1016/j.ekir.2017.12.008.

Lokuge K, Waard DD, Halliday A, Gray A, Bulbulia R*, Mihaylova B*. Meta-analysis of the procedural risks of carotid endarterectomy and carotid artery stenting over time. British Journal of Surgery 2017.

Clayton G, Smith I, Higgins JPT, Mihaylova B, Thorpe B, Cicero R, Lokuge K, Forman J, Tierney JF, White IR, Sharples LD, Jones HE. The INVEST project: Investigating the use of evidence synthesis in the design and analysis of clinical trials. Trials. 2017. 18:219.

Kent S, Fusco F, Gray A, Jebb SA, Cairns BJ*, Mihaylova B*. Body mass index and healthcare costs: a systematic literature review of individual participant data studies. Obesity Reviews. 2017. 18:869-79.

Castellani J, Mihaylova B, Ajayi IO, Siribie M, Nsungwa-Sabiiti J, Afonne C, Serme L, Balyeku A, Kabarungi V, Kyaligonza J, Evers SM, Paulus AT, Petzold M, Singlovic J and Gomes M. Quantifying and Valuing Community Health Worker Time in Improving Access to Malaria Diagnosis and Treatment. Clin Infect Dis. 2016;63:S298-S305.

Castellani J, Nsungwa-Sabiiti J, Mihaylova B, Ajayi IO, Siribie M, Afonne C, Balyeku A, Serme L, Sanou AK, Sombie BS, Tiono AB, Sirima SB, Kabarungi V, Falade CO, Kyaligonza J, Evers SM, Paulus AT, Petzold M, Singlovic J and Gomes M. Impact of Improving Community-Based Access to Malaria Diagnosis and Treatment on Household Costs. Clin Infect Dis. 2016;63:S256-S263.

Herrington W, Emberson J, Mihaylova B, Collins R, Baigent C. Are statins useful in patients with advanced chronic kidney disease? – Authors' reply. Lancet Diabetes and Endocrinology. 2016. 4: 971–2.

Achelrod D, Gray A, Preiss D, Mihaylova B. Cholesterol- and blood pressure-lowering drug use for secondary cardiovascular prevention in 2004-2013 Europe. European Journal of Preventive Cardiology. 2016;24: 426–436.

Reith C, Blackwell L, Emberson J, Mihaylova B, Armitage J, Fulcher J, Keech A, Simes J, Baigent C, Collins,R. Protocol for analyses of adverse event data from randomized controlled trials of statin therapy. American Heart Journal. 2016; 176:63-9.

Morton RL, Schlackow I, Staplin N, Gray A, Cass A, Haynes R, Emberson J, Herrington W, Landray M, Baigent C, Mihaylova B. Impact of educational attainment on health outcomes in moderate-to-severe chronic kidney disease. American Journal of Kidney Diseases. 2016; 67(1): 31-39.

Morton RL, Schlackow I, Mihaylova B, Staplin N, Gray A, Cass A, The impact of social disadvantage in moderate to severe chronic kidney disease: an equity-focused systematic review. Nephrology Dialysis Transplantation 2016; 31:46-56.

Kent S, Schlackow I, Lozano-Kuhne J, Reith C, Emberson J, Haynes R, Gray A, Cass A, Baigent C, Landray MJ, Herrington W, Mihaylova B. What is the impact of chronic kidney disease stage and cardiovascular disease on the annual cost of hospital care in moderate-to-severe kidney disease? BMC Nephrol. 2015;16(1):65.

Castellani J, Mihaylova B, Evers SM, Paulus AT, Mrango ZE, Kimbute O, Shishira JP, Mulokozi F, Petzold M, Singlovic J, Gomes M. Out-of-Pocket Costs and Other Determinants of Access to Healthcare for Children with Febrile Illnesses: A Case-Control Study in Rural Tanzania. PLoS One. 2015;10(4):e0122386.

Cholesterol Treatment Trialists’ (CTT) Collaboration (Writing Committee: Fulcher J, O'Connell R, Voysey M, Emberson J, Blackwell L, Mihaylova B, Simes J, Collins R., Kirby A, Colhoun H, Braunwald E, La Rosa J, Pedersen T R, Tonkin A, Davis B, Sleight P, Franzosi MJ, Baigent C, Keech A). Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174 000 participants in 27 randomised trials. Lancet 2015; 385(9976):1397-1405.

Alva M L, Gray A, Mihaylova B, Leal J, Holman R R. The impact of diabetes-related complications on healthcare costs: new results from the UK Prospective Diabetes Study. Diabetic Medicine 2014; 32(4):459-466.

Alva M, Gray A, Mihaylova B, Clarke P. The effect of diabetes complications on health-related quality of life: the importance of longitudinal data to address patient heterogeneity. Health Economics. 2014; 23(4): 487-500.

Mihaylova B, Emberson J, Keech A, Collins R, Baigent C, on behalf of Cholesterol Treatment Trialists’ (CTT) Collaborators. Statins for people at low risk of cardiovascular disease. Reply. Lancet. 2012;380(9856):1817-8.

Buchanan J, Mihaylova B, Gray A, White N. Cost-effectiveness of pre-referral antimalarial, antibacterial, and combined rectal formulations for severe febrile illness. PLoS ONE 2010;5(12):e14446.

Mihaylova B, Pitman R, Tincello D, van der Vaart H, Tunn R, Timlin L, Quail D, Johns A, Sculpher M. Cost-effectiveness of duloxetine: the Stress Urinary Incontinence Treatment (SUIT) study. Value in Health 2010;13(5):565-72.

Mihaylova B, Briggs A, Hlatky M, Armitage J, Parish S, Gray A, and Collins R. Statin cost-effectiveness in the United States for people at different vascular risk levels. Circulation: Cardiovascular Quality and Outcomes 2009;2:65-72.

Briggs A, Mihaylova B, Sculpher M, Hall A, Wolstenholme J, Simoons M, Deckers J, Roberto F, Remme WJ, Bertrand M, and Fox K. The Cost-effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA Study. Heart 2007;93: 1081-6.

Bryant J, Loveman E, Chase D, Mihaylova B, Cave C, Gerard K, Milne R, The clinical effectiveness and cost effectiveness of the use of human growth hormones in adults. Health Technology Assessment 2002;6(19):1-106.

Bryant J, Cave C, Mihaylova B, Chase D, McIntyre L, Gerard K, Milne R, Clinical effectiveness and cost-effectiveness of growth hormone in children: a systematic review and economic evaluation. Health Technology Assessment 2002; 6(18):1-168.

(*equal contributions)


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