The socioeconomic burden of age-related macular degeneration and diabetic macular edema in Bulgaria: Evidence from cost-of-illness analyses and clinical pathway assessment

Population aging and the increasing prevalence of diabetes are contributing to the growing burden of age-related macular degeneration (AMD) and diabetic macular edema (DME) in Bulgaria. This short communication summarizes recent evidence on clinical care pathways and the socioeconomic impact of these conditions, based on published cost-of-illness (COI) and socioeconomic burden analyses. Available data point to substantial losses along the care pathway, with low diagnosis and treatment rates leading to delayed intervention and poorer outcomes. The average annual cost per patient with neovascular AMD in Bulgaria is estimated at €21,722, with most costs arising from reduced quality of life, productivity losses, and welfare losses rather than direct medical care. At the population level, the annual economic burden of neovascular AMD is estimated at €228.9 million. When AMD and DME are considered together, the total socioeconomic burden reached €545.7 million during 2017–2023 and is projected to rise to €1.39 billion by 2032. These findings indicate a considerable and increasing societal impact, highlighting the importance of earlier detection and more coordinated eye care in Bulgaria.