The Societal Impact and Economic Burden of Peripheral Artery Disease in Bulgaria

OBJECTIVES: Peripheral artery disease (PAD) encompasses a group of conditions that cause progressive stenosis and/or thrombosis, or enlargement of the aorta and its branches, including the carotid arteries, upper extremity arteries, visceral arteries, and lower extremity arteries. Approximately 95% of chronic PAD cases are attributed to atherosclerosis. Epidemiologic studies using objective research techniques indicate that PAD prevalence in the general population ranges from 3% to 10%. A 2021 epidemiological study found a PAD prevalence of 7.82% in Bulgaria.

METHODS: An economic evaluation estimates that the direct medical costs for the PAD-affected population in Bulgaria amounts to BGN 450,720,289.32. Of this, BGN 98,413,752.33 is spent by patients and the National Health Insurance Fund (NHIF) on pharmacotherapy. Medical services costs are estimated to be BGN 352,306,536.99, which is 7.10% of the total medical services cost under the National Framework Agreement (NFA) 2023-2025. This analysis highlights the significant financial burden PAD imposes on the NHIF for both pharmacotherapy and medical services. Improved disease monitoring could reduce these costs.

RESULTS: Additionally, indirect costs due to lost GDP contribution are estimated at BGN 672,898,075.96 annually, comprising BGN 342,337,403.76 from absenteeism and BGN 330,560,672.20 from presenteeism (50% impaired productivity). This loss represents 0.4% of Bulgaria's GDP for 2022.

CONCLUSIONS: In conclusion, PAD poses a significant social, health, and economic burden in Bulgaria. Effective and well-organized treatment is essential to better control and reduce the impact of this disease.