Cardio-renal-metabolic modeling in Asia-Pacific: projections of clinical and economic burden and empagliflozin's impact on burden reduction.

AIMS: The global prevalence of cardio-renal-metabolic (CRM) conditions, including chronic kidney disease, heart failure, type 2 diabetes in interconnected pathophysiology, is rapidly increasing. This presents health/economic consequences for Asia-Pacific (APAC) countries experiencing substantial disease burden. We aimed to forecast the regional clinical/economic burden of comorbid CRM conditions and evaluate the potential impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors on burden reduction, with empagliflozin as the modeled intervention.

METHODS

A Markov model (10-year time horizon [2024-2033]; annual cycle length) was developed and adapted for selected Southeast Asian countries (Malaysia/the Philippines/Thailand/Vietnam/Singapore), Australia, and South Korea using published local epidemiological and economic data. Future CRM disease prevalence, as well as the modeled SGLT2 inhibitor empagliflozin's potential in reducing clinical burden (prevalence/mortality) and associated healthcare resource use (HCRU) costs, were estimated. Empagliflozin cost was excluded from HCRU calculations to isolate/evaluate the economic burden of CRM conditions.

RESULTS

Projecting the current disease trends (without SGLT2 inhibitors), the total number of patients with comorbid CRM conditions and deaths in Southeast Asia/Australia/South Korea would increase ∼3-fold from 19.0 million/968,000/2.6 million (2024) to 63.4 million/3.1 million/7.1 million (2033). Guideline-recommended use of SGLT2 inhibitor empagliflozin is estimated to prevent 925,000/19,100/105,000 patients from developing comorbid conditions and ∼1.9 million/50,000/174,000 deaths in Southeast Asia/Australia/South Korea by 2033. After excluding empagliflozin cost, these reductions translate to discounted cumulative cost savings for Southeast Asia (Malaysia: RM16.9 billion/the Philippines: ₱775.6 billion/Thailand: ฿973.7 billion/Vietnam: 148.0 trillion ₫/Singapore: S$1.1 billion), Australia (AU$23.2 billion), and South Korea (₩42.4 trillion). Varying the parameters of the deterministic sensitivity analysis resulted in upper and lower estimates of economic burden that differed by no more than 10% from the mean economic burden of each health state across the seven APAC countries.

LIMITATIONS: Underreporting/variability in local epidemiological data potentially affected burden projection accuracy. Insufficient available data on comorbid CRM conditions across countries necessitated model input assumptions, which may have introduced uncertainties.

CONCLUSIONS

Substantial increases in comorbid CRM disease prevalence and associated healthcare resource strain in APAC are expected over the next decade. Guideline-directed SGLT2 inhibitor use, with empagliflozin as an example, may alleviate regional clinical and economic burden.