ECONOMIC EVALUATIONS OF HYPERTENSION INTERVENTIONS IN PREGNANCY LACK STANDARDISATION: RESULTS OF A SYSTEMATIC REVIEW
Author(s)
Ling Jie Cheng, PhD, MPH, BSN (Hons), RN1, Lucy Abel, MSc2, Svetlana Ratushnyak, MSc, MD1, Oliver Rivero-Arias, MSc, DPhil1, Richard McManus, PhD FRCGP3, Lucy Chappell, PhD4, Helen Campbell, DPhil1.
1National Perinatal Epidemiology Unit, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom, 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom, 3Deans Office, Brighton and Sussex Medical School, University of Brighton and University of Sussex, Brighton, United Kingdom, 4Department of Women and Children's Health, Kings College London, London, United Kingdom.
1National Perinatal Epidemiology Unit, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom, 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom, 3Deans Office, Brighton and Sussex Medical School, University of Brighton and University of Sussex, Brighton, United Kingdom, 4Department of Women and Children's Health, Kings College London, London, United Kingdom.
Presentation Documents
OBJECTIVES: Hypertensive disorders of pregnancy (HDP), including pre-eclampsia, affect 5-10% of pregnancies globally, causing approximately 46,000 maternal and 500,000 fetal/newborn deaths annually. Women face elevated lifelong risks of cardiovascular disease, whilst infants experience increased risks of prematurity and neurodevelopmental complications. Whilst HDP interventions are increasingly evaluated for cost-effectiveness, analysts face methodological challenges in capturing outcomes for both affected parties and modelling long-term consequences. This systematic review examines how economic evaluations have been conducted, focusing on methodological approaches, outcome measurement, study perspectives, time horizons, and cost-effectiveness conclusions.
METHODS: Following PRISMA 2020 guidelines, we searched Medline, Embase, EconLit, and Web of Science from inception to 31 December 2024 for cost-effectiveness, cost-utility, cost-benefit, cost-consequence, and cost-minimisation analyses of HDP interventions. An updated search was conducted on 4 November 2025. Data on costs, outcomes, and methodology were extracted. Reporting quality was evaluated using the CHEERS 2022 checklist.
RESULTS: Thirty-five studies were included, predominantly from high-income countries, covering prevention, screening, diagnosis, and management interventions. One-third of cost-effectiveness/cost-utility studies reported only women's outcomes. Amongst studies considering both woman and infant, 62.5% presented cost-effectiveness estimates for only one party. Only 20% modelled lifetime horizons; none utilised multi-state Markov frameworks to capture long-term maternal cardiovascular risks or infant prematurity complications. Most studies (86%) adopted healthcare perspectives only. Screening, prevention, and diagnostic interventions were frequently cost-effective (57% showing dominance). However, most reported cost per pre-eclampsia case averted with fewer applying broader measures (e.g., maternal/infant QALYs), thus limiting comparability.
CONCLUSIONS: Economic evaluations of HDP interventions demonstrate substantial methodological heterogeneity. Future research should adopt lifetime horizons, incorporate outcomes for both women and infants, utilise societal perspectives, apply standardised quality-adjusted life years, and model progression to long-term conditions. Addressing these gaps is essential to ensure cost-effectiveness evidence captures the full value of HDP interventions and informs resource allocation optimising maternal and neonatal health.
METHODS: Following PRISMA 2020 guidelines, we searched Medline, Embase, EconLit, and Web of Science from inception to 31 December 2024 for cost-effectiveness, cost-utility, cost-benefit, cost-consequence, and cost-minimisation analyses of HDP interventions. An updated search was conducted on 4 November 2025. Data on costs, outcomes, and methodology were extracted. Reporting quality was evaluated using the CHEERS 2022 checklist.
RESULTS: Thirty-five studies were included, predominantly from high-income countries, covering prevention, screening, diagnosis, and management interventions. One-third of cost-effectiveness/cost-utility studies reported only women's outcomes. Amongst studies considering both woman and infant, 62.5% presented cost-effectiveness estimates for only one party. Only 20% modelled lifetime horizons; none utilised multi-state Markov frameworks to capture long-term maternal cardiovascular risks or infant prematurity complications. Most studies (86%) adopted healthcare perspectives only. Screening, prevention, and diagnostic interventions were frequently cost-effective (57% showing dominance). However, most reported cost per pre-eclampsia case averted with fewer applying broader measures (e.g., maternal/infant QALYs), thus limiting comparability.
CONCLUSIONS: Economic evaluations of HDP interventions demonstrate substantial methodological heterogeneity. Future research should adopt lifetime horizons, incorporate outcomes for both women and infants, utilise societal perspectives, apply standardised quality-adjusted life years, and model progression to long-term conditions. Addressing these gaps is essential to ensure cost-effectiveness evidence captures the full value of HDP interventions and informs resource allocation optimising maternal and neonatal health.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE173
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Trial-Based Economic Evaluation
Disease
SDC: Reproductive & Sexual Health