Presentation (CTI)

OBJECTIVES: This scoping review systematically identified and assessed economic evidence on hypertension in Europe to map financial and welfare burden; scope interventions supporting health technology assessment; characterize economic analysis methods and quality; and identify methodological gaps and research opportunities.
METHODS: We searched Embase, PubMed, and EconLit for empirical studies (January 2014-August 2024) assessing burden size and examining healthcare interventions or policies related to hypertension in Europe. Eligible studies included burden-of-disease, cost-of-illness, intervention cost analyses, choice experiments, and full/partial economic evaluations. Studies required economic outcomes reporting and intervention comparisons to standard care. Both randomised and non-randomised designs were included. Two reviewers independently screened and extracted data, with disagreements resolved through third reviewer. Quality of reporting was assessed using CHEERS checklist.
RESULTS: We identified 46 studies, predominantly from Western Europe with limited Central/Eastern European representation. Societal impact was assessed through burden-of-disease (n=2) and cost-of-illness (n=6) studies. Thirty-five intervention studies examined patient-level interventions (pharmacotherapy, adherence, diagnostics, devices), population-level policies (public health, pharmaceutical policy), and health-system strategies (clinical guidelines, quality improvement, digital health). Only 15 studies conducted full cost-effectiveness evaluations, primarily from the UK (n=9). Most adopted payer perspectives with lifetime horizons and employed combined RCT-modeling approaches (n=10). Cost-utility analyses using QALYs were most common. Incremental cost-effectiveness ratios showed substantial variation for identical interventions, being 65% higher for women versus men (€107,241 vs €64,963/QALY) and varying six-fold across healthcare settings (€10,092/QALY in Germany vs €64,963/QALY in Spain). Only nine studies incorporated equity considerations. Funding was predominantly public sector, with industry funding device interventions.
CONCLUSIONS: Despite hypertension’s substantial clinical and economic burden in Europe, economic evidence remains fragmented, with ICERs varying widely across settings and methodological differences limiting comparability and synthesis. Healthcare system heterogeneity necessitates context-specific economic evidence for health technology assessment. Current cost analyses are insufficient; comprehensive economic evaluations incorporating incremental costs, benefits, and equity dimensions are warranted.