Metabolic syndrome is a cluster of interconnected conditions including hypertension, abnormal cholesterol levels, high blood sugar, and central obesity that collectively increase the risk of cardiovascular diseases and type 2 diabetes. The prevalence is highest in the Americas and Eastern Mediterranean WHO regions, with a disproportionate burden of deaths in low- and middle-income countries. In Thailand, metabolic syndrome affects around 20–27% of the population, with rates rising to nearly 58% among those with sedentary lifestyles. The condition is especially common among individuals with lower incomes and middle-class occupations. These trends, driven by lifestyle and dietary factors, underscore the need for early interventions that combine behavioral and pharmaceutical strategies to prevent disease progression.

Diagnosis is typically made when individuals present at least three risk factors, often accompanied by comorbidities such as obesity and type 2 diabetes. The rising prevalence of metabolic syndrome over the past decades has paralleled increases in obesity and insulin resistance-related conditions. Approximately 85% of people with type 2 diabetes also meet the criteria for metabolic syndrome, heightening their risk for cardiovascular complications. This overlap highlights the importance of personalized, comprehensive treatment strategies that take into account the complex interplay of multiple health conditions when designing public health interventions.

Management approaches in Thailand begin with lifestyle changes and progress to pharmacological treatments, although pharmacological interventions can often lead to undesirable side effects. Alternatives like herbal and nutraceutical therapies are being explored for their effectiveness and reduced toxicity. Furthermore, the second National Herbal Action Plan (2024-2027), by the Ministry of Public Health, states a policy to promote cooperation between the public and private sectors to develop and raise the quality of Thai traditional medical products. The plan aims to create more value for Thai herbs, improve their quality and standards, and enhance their competitiveness in both local and international markets. Fostering research and development of Thai herbal medicines can unlock the full potential of traditional Thai herbs, harness their inherent therapeutic properties, and expand their adoptions in the modern healthcare system. The early HTA of the Combined Extract of Mulberry Fruit and Ginger for Antimetabolic Syndrome will provide necessary information for identifying the gaps in care and management of metabolic syndrome and product positioning in Thailand’s healthcare system. In addition, this study will provide information to inform clinical trial designs for the innovators as well as pricing strategies that can lead to National List of Essential Medicines (NLEM) inclusion and public reimbursement the future.