Case Study

A whole-system cardiorenal disease model


Health economic evaluations are typically performed at a specific point within a pathway of care. This relatively narrow focus has potential to overlook important consequences to the healthcare system within strategic policy decision-making.

Type 2 diabetes (T2D), heart failure (HF), and chronic kidney disease (CKD) often occur together (cardiorenal disease), owing to shared risk factors and the bidirectional effect between the heart and kidneys.

Strong evidence suggests that SGLT2 inhibitors exhibit cardio and renal protective effects beyond that expected based upon their glycaemia or glycosuria effects.

Current modelling approaches underestimate the benefit of SGLT2 inhibitors as they are isolated to one disease area at a specific point.


We proposed a broader whole-disease approach to assess disease burden and the value of therapeutic innovation.

A model was developed to estimate the future burden associated with managing T2D, HF and CKD in terms of costs and resource use.

The model used published literature on prevalence, incidence and mortality to project results up to the year 2040.

Current treatment was compared with SGLT2 inhibitors (dapagliflozin, canagliflozin, empagliflozin) and sacubitril & valsartan.


A holistic economic assessment that provided a broader perspective of the impact of therapy innovation.

The whole-system cardio-renal disease model combined all published evidence for SGLT2 inhibitors to demonstrate the potential benefits that could be realised in cardiorenal medicine from a holistic whole-disease perspective.

The study culminated in publication in a peer-reviewed journal; McEwan et al. J Manag Care Spec Pharm, 2022 Apr;28(4):415-424.