# Mortality and Economic Burden of Prostate Cancer in Bulgaria: Years of Life Lost, Working Years of Life Lost, and Indirect Costs (2008–2023)

## TL;DR

This study assesses the health and economic impact of prostate cancer in Bulgaria from 2008 to 2023, showing rising mortality and productivity losses.

## Contribution

The study provides new insights into the economic and health burden of prostate cancer in Bulgaria using YLL, YWLL, and indirect cost metrics.

## Key findings

- Prostate cancer caused 127,457 years of life lost and 6345 working years of life lost in Bulgaria from 2008 to 2023.
- Productivity losses due to prostate cancer reached €88.2 million during the study period.
- Mortality increased until 2020, but working years of life lost decreased as deaths shifted to older age groups.

## Abstract

Background/Objectives: Prostate cancer is the second most common cause of cancer-related mortality among the male population worldwide. It is among the leading reasons for the increasing number of years of life lost, working years of life lost, and gross domestic product (GDP) loss in Bulgaria. The primary objective of this study is to evaluate the burden of prostate cancer in Bulgaria, including calculating years of life lost (YLL), years of working life lost (YWLL), and the associated indirect costs. Methods: An observational time-series study was conducted using official national data from the National Statistical Institute (NSI), the INFOSTAT database, and the National Social Security Institute. The study covered the period 2008–2023 and included all registered male deaths attributed to malignant neoplasm of the prostate (ICD-10: C61). YLL, YWLL, and indirect costs were calculated using the human capital approach. Due to restricted access to age-specific mortality files, additional mortality records were obtained through formal data requests to NSI. Results: Prostate cancer led to 127,457 YLL and 6345 YWLL, with productivity losses reaching €88.2 million. Mortality showed an overall increasing trend up to 2020, while YWLL declined due to deaths shifting to older age groups. Conclusions: Despite the advancements in prostate cancer diagnosis and treatment, our findings demonstrate a negative trend regarding YLL, YWLL, and indirect costs associated with the disease, in contrast to other European countries. Strengthening early screening, reducing diagnostic delays, and improving national cancer registry capacity are critical to mitigating future health and economic losses.