Presentation (CTI)

OBJECTIVES: To synthesise existing evidence on the economic evaluation of interventions for managing people living with two or more long-term conditions (MLTC), across diverse populations, healthcare settings, and geographical contexts, and to appraise reporting and methodological quality.
METHODS: Nine databases were searched from inception to November 2025, including MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, CENTRAL, Research Papers in Economics, and the Tufts CEA Registry, with Google Scholar for grey literature. Eligible studies were full economic evaluations (cost-utility, cost-effectiveness, cost-benefit, cost-consequence analysis) of interventions targeting two or more co-occurring chronic conditions, with no restrictions on country or healthcare setting. Reporting quality was assessed using CHEERS 2022; methodological quality using the Drummond checklist (for trial-based and observational studies) and Philips checklist (for model-based studies).
RESULTS: 73 studies (1998-2025) were included (52 trial-based, 14 model-based, 7 observational). Seven intervention models were identified: integrated/coordinated care (n=31), psychological and behavioural (n=19), self-management support (n=7), pharmacological optimisation (n=5), digital health (n=4), physical activity and environmental (n=4), pharmacotherapy intensification (n=3). Cost-utility analysis was predominant (n=56, 76.7%). Results were broadly supportive of cost-effectiveness: pharmacological optimisation studies all reported dominant or below-threshold results; psychological and behavioural interventions showed favourable results; integrated care showed greatest heterogeneity. 41.1% targeted mental-physical comorbidity, 28 of 30 addressing depression; seven from low- and middle-income countries. Reporting quality was variable; perspective, time horizon, and uncertainty analysis were frequently incomplete. CHEERS and Drummond scores were not correlated: reporting quality did not correspond to methodological rigour. CHEERS and Philips scores were positively associated in model-based studies, though some with adequate CHEERS scores had Philips weaknesses in uncertainty and model validation.
CONCLUSIONS: Economic evidence broadly supports cost-effectiveness of MLTC-targeted interventions, particularly pharmacological optimisation and psychological approaches. Evidence from low- and middle-income countries and condition combinations beyond depression-physical multimorbidity remains sparse, limiting generalisability for settings where MLTC burden is growing fastest.