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

IntroductionIntegrated care is increasingly being adopted to address the complex needs of patients with cardiometabolic multimorbidity. However, it is unclear how to cost-effectively configure health service pathways for these patients. This study aimed to review and appraise decision analytic models (DAMs) used in economic evaluations of integrated care interventions for patients with cardiometabolic multimorbidity. MethodsWe conducted a systematic search for peer-reviewed articles in eight electronic databases, published in English language until December 2023. Any study worldwide that used a decision-analytic model to conduct an economic evaluation of an integrated care model for patients with cardiometabolic multimorbidity was included. We summarised characteristics of the DAMs, integrated care models evaluated, diseases constituting multimorbidity, and critically appraised the quality of reporting of the economic evaluations using Philips (2006) checklist. ResultsOut of 16 model-based assessments of the differences between alternative integrated care pathways, most studies (n=13, 81%) were cost utility analyses, focused on care for patients with hypertension and/or diabetes concordant multimorbidity (n=11, 69%). Most studies were conducted in high-income countries (n = 11, 69%). More than half (n = 10, 63%) of the studies used simulated Markov models, while only three studies used individual sampling (microsimulation) models. Few studies were explicit about their data validation approaches against local data, quality of data incorporated in the models, and internal and external consistency. ConclusionDecision-analytic models investigating integrated care pathways for cardiometabolic multimorbidity should employ microsimulation to describe and incorporate repeated patient interactions with health care and multimorbidity outcomes in the economic evaluations. Consideration of uncertainty in data sources and model structure is also needed to provide robust conclusions. The study also highlighted the need for more economic evaluations using DAMs in low- and middle-income countries to evaluate integrated care models in the context of cardiometabolic multimorbidity.