Application of decision-analytic models to evaluate integrated care interventions for cardiometabolic multimorbidity: a systematic review

Introduction: Integrated care is increasingly adopted to address the needs of patients with multimorbidity, but cost-effective configuration of integrated healthcare pathways remains unclear. This study reviewed decision analytic models (DAMs) used in economic evaluations of integrated care interventions for cardiometabolic multimorbidity.

Methods: A systematic search of eight electronic databases was conducted to identify peer-reviewed articles published in English until November 2024. Studies using DAMs to evaluate integrated care interventions for patients at risk or having cardiometabolic multimorbidity were included. Data on DAMs characteristics, integrated care models evaluated, and diseases were summarised. The quality of reporting was assessed using Philips (2006) checklist.

Results: Sixteen studies met inclusion criteria. Most studies (81%) were cost utility analyses, focused on hypertension and/or diabetes concordant multimorbidity (69%). High-income countries accounted for 69% of the studies. Markov models were used the most (63%), with only three studies employing individual patient simulation (microsimulation) models. Few studies were explicit about data validation and reporting uncertainty.

Conclusion: Economic evaluations of integrated care cardiometabolic multimorbidity should adopt microsimulation to better capture patient-level interactions and health outcomes. Better reporting of validation and uncertainty is needed. There is limited application of DAM-based economic evaluations of integrated care in low- and middle-income countries.