Presentation (CTI)

OBJECTIVES: Underdiagnosis and suboptimal treatment of long-term conditions drive inefficiency and poor outcomes, with documented care gaps across hypertension, diabetes and respiratory disease. This analysis quantifies the clinical and economic burden of cardiovascular-kidney-metabolic (CKM) multimorbidity and models a prevention-first approach across population, system, employer and macroeconomic dimensions in England.
METHODS: CF used NHS England secondary-care cost data (2023/24), HES/ONS data across five condition clusters (cardiovascular disease, type 2 diabetes, obesity, chronic kidney disease, dementia). Diagnosis and treatment gaps were estimated from population prevalence and registry data against NICE-aligned pathways; healthcare resource utilisation savings were modelled under optimised risk-factor management. Obesity-associated relative risks were derived from HES comparisons, and per-person cost variation assessed across regions by deprivation.
RESULTS: CKM conditions account for ~45% of chronic-disease burden and ~56% of acute costs in England (~£26bn annually), yet few achieve optimal treatment (37% of CVD patients at lipid targets; 28% of eligible type 2 diabetes at HbA1c target; 54% of people with obesity diagnosed). Obesity (BMI >30) raised relative risk for hypertensive heart disease (2.6), type 2 diabetes (2.5), CKD (2.1), osteoarthritis (2.7) and gout (2.5). Better detection and management could avert 3.4 million CVD events and save ~£12bn/year in secondary care and ~£2.2bn in primary-care/polypharmacy avoidance; CF sizes £6.1-9.2bn from closing care gaps alone. Per-person acute cost for most-deprived 20% patients with multimorbidity (£3.54k) closely tracked the rest of the population (£3.50k) but with materially greater between-area variation indicating systematic underservice in deprived areas.
CONCLUSIONS: The consequences of unmet care extend beyond NHS budgets to employers, insurers and the Treasury. Earlier intervention on upstream drivers, particularly obesity, and equitable delivery to most deprived populations are the highest-yield opportunities; realising this value requires targeted eligibility, diagnostic-led risk stratification and funding models that align incentives across payers, systems and government.