Research motivation and background
The authors have conducted extensive work in the cardio-kidney-metabolic space, and while the interrelationships between these diseases are well known, they have consistently observed that such connections are not adequately considered in economic assessments of treatments or in healthcare capacity planning. Understanding the overlaps in prevalence among these interrelated diseases is a crucial first step toward recognising the hidden value of treatments that offer patient benefits across multiple conditions. This perspective also helps to illustrate the interdependencies between diseases and how addressing one area may lead to unintended consequences in another.

Originality and contribution
The authors extrapolated the NHANES dataset to understand the overlap between six interrelated diseases from 2006 to 2023 and demonstrated how the prevalence of each disease has independently grown faster than the population. They presented the overlaps between the sixty-four combinations of morbidities using upset graphs, which strongly highlight the importance of considering multimorbidity in future studies.

Relevance and impact
The authors hope that this work draws attention to the significant overlaps between the diseases included and evidences the need for multi-indication economic assessments of treatments such as GLP1-RAs or SGLT2is, which offer patient benefit across the cardio-kidney-metabolic spectrum.

Methodology and approach
Epidemiological studies frequently focus on a single ‘primary’ disease. However, in this work, the authors quantified the sixty-four distinct combinations. In doing so, they highlight the significant proportion of people with multiple interrelated morbidities.

Stakeholder engagement
The growth of multimorbidity in the US population is significant, with the proportion of US adults growing by 86% over the seventeen-year period. These patients pose an increasing clinical challenge, and it is therefore paramount that this trajectory be corrected through holistic management and through holistic value assessments of interventions.

If you have any questions about the research or would like to discuss your specific challenge and potential solutions, please contact Thomas Padgett, Principal Operational Researcher at HEOR: thomas.padgett@heor.co.uk.