The Socio-Economic Burden of Terminal Cancer: Real-World Evidence From Bulgaria
Author(s)
Elizabet K. Dzhambazova, PhD1, Kostadin Rangelov Kostadinov, PhD, MPH, MD2, Fares Ezeldin, MD3, Georgi Iskrov, PhD, MPH2.
1PHD Researcher, Medical University of Plovdiv, Plovdiv, Bulgaria, 2Social Medicine and Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria, 3Medical University of Plovdiv, Plovdiv, Bulgaria.
1PHD Researcher, Medical University of Plovdiv, Plovdiv, Bulgaria, 2Social Medicine and Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria, 3Medical University of Plovdiv, Plovdiv, Bulgaria.
OBJECTIVES: We aimed to collect and assess real-world evidence on the socioeconomic burden of terminal cancer patients in Bulgaria.
METHODS: We conducted a single-center cost-of-illness study on adult terminal cancer patients receiving palliative care in either inpatient or outpatient settings at a tertiary healthcare facility. The socioeconomic burden was defined as the combination of direct healthcare costs, direct non-healthcare costs, and productivity losses for both patients and caregivers. We applied a prevalence-based, bottom-up costing approach to measure the socioeconomic burden from a societal perspective. Patients or their caregivers reported their real-world utilization of healthcare services, social support, formal and informal care in the community, and any work or productivity limitations. We then multiplied the reported resource utilization by the reference prices for 2024.
RESULTS: Thirty-two patients participated in the study. The median age was 71.5 years, with a median time since diagnosis of one year. Breast cancer was the most common type (31.3%). About half of the patients (53.1%) were receiving palliative care and/or chemotherapy. The median annual socioeconomic burden was €12,088.45 per patient, with private costs contributing approximately one-third. Hospitalizations were the largest cost driver, followed by productivity losses among patients and caregivers, as well as expenses for medical devices and consumables. A younger age at diagnosis and the need for a caregiver were associated with a higher socioeconomic burden. Participants reported limited or no utilization of social services and mental health care.
CONCLUSIONS: This study provides the first real-world evidence on the socioeconomic burden of terminal cancer in Bulgaria. We recommend implementing new outpatient and home-based services to support affected individuals and their families. Additionally, enhancing cancer screening and early diagnosis could indirectly reduce the burden of terminal cancer in Bulgaria.
METHODS: We conducted a single-center cost-of-illness study on adult terminal cancer patients receiving palliative care in either inpatient or outpatient settings at a tertiary healthcare facility. The socioeconomic burden was defined as the combination of direct healthcare costs, direct non-healthcare costs, and productivity losses for both patients and caregivers. We applied a prevalence-based, bottom-up costing approach to measure the socioeconomic burden from a societal perspective. Patients or their caregivers reported their real-world utilization of healthcare services, social support, formal and informal care in the community, and any work or productivity limitations. We then multiplied the reported resource utilization by the reference prices for 2024.
RESULTS: Thirty-two patients participated in the study. The median age was 71.5 years, with a median time since diagnosis of one year. Breast cancer was the most common type (31.3%). About half of the patients (53.1%) were receiving palliative care and/or chemotherapy. The median annual socioeconomic burden was €12,088.45 per patient, with private costs contributing approximately one-third. Hospitalizations were the largest cost driver, followed by productivity losses among patients and caregivers, as well as expenses for medical devices and consumables. A younger age at diagnosis and the need for a caregiver were associated with a higher socioeconomic burden. Participants reported limited or no utilization of social services and mental health care.
CONCLUSIONS: This study provides the first real-world evidence on the socioeconomic burden of terminal cancer in Bulgaria. We recommend implementing new outpatient and home-based services to support affected individuals and their families. Additionally, enhancing cancer screening and early diagnosis could indirectly reduce the burden of terminal cancer in Bulgaria.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD235
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology