Cardiovascular-Kidney-Metabolic Syndrome: Conceptualising an Approach to Health Economic Modelling.

aimsCardiovascular-kidney-metabolic (CKM) syndrome has developed into a global public health crisis. Although integrated care is increasingly used to treat patients with CKM, current health economic models fail to capture the value of considering the CKM syndrome as a unified condition. We present a conceptual framework to guide development of a new health economic model that captures value holistically across interconnected CKM domains. MATERIALS AND

methodsFollowing best-practice guidelines, we undertook a review of published literature to identify and connect the key biological drivers of the CKM syndrome. These insights were synthesised into a biological framework, which was simplified into a streamlined influence diagram of sufficient complexity to guide model development. Both framework and diagram were iteratively reviewed and developed based on feedback from clinicians, health economists and modelling specialists.

resultsA biological framework and influence diagram were developed to illustrate how the CKM syndrome's biological drivers interconnect and link to key clinical outcomes. We detail the components of these diagrams, explaining the rationale behind connections. We discuss how the proposed framework could inform a model for future health economic evaluation.

conclusionThere is a clear unmet need for comprehensive modelling of the CKM syndrome to support evidence-based decision-making and guide management of this highly prevalent, far-reaching disease. As more evidence has become available, the mathematical development, in the near future, of a long-term, holistic and flexible health economic model has become feasible, despite some gaps. This work seeks to shape a shared understanding of the challenges and opportunities in this developing field.