Lise Retat

Uncontrolled hypertension (ucHTN) and treatment-resistant hypertension (trHTN) are associated with a substantial increase in the risk of cardiorenal events and mortality compared with well-controlled hypertension. Treatment strategies that can optimise blood pressure management are urgently needed to improve health outcomes in ucHTN and trHTN populations; health economic models play a key role in assessing the economic value of new and existing treatments and supporting resource allocation. This systematic literature review critically assesses the construct and quality of existing health economic modelling used in the evaluation of management approaches for ucHTN and trHTN, to inform the design and development of future health economic models. This review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. Searches were conducted on Medline, Embase, EconLit, the Cost-effectiveness Analysis and the International HTA database. Searches were run from inception to May 2024 and re-run in February 2026. Although no date limits were placed on the electronic searches, a limit of 2005 and onwards was applied during study selection. Economic model studies were included if they assessed pharmacological or renal denervation (RDN) interventions for treatment of either ucHTN or trHTN in adult populations. Study eligibility, data extraction and quality assessment using the Drummond checklist were conducted independently by two reviewers. After deduplication, a total of 2754 records were identified. Of these, 2556 did not meet the eligibility criteria after title and abstract screening; 198 full texts were reassessed for eligibility. A total of 21 modelling studies were included: 16 economic evaluations (14 cost-utility analyses, 1 cost-effectiveness analysis and 1 cost-minimization analysis), 4 burden-of-illness studies and 1 budget impact analysis. The majority of studies focused on people with ucHTN and employed a healthcare system perspective. Economic evaluations were based on treatment effects on systolic blood pressure estimated from clinical trials. Several models predicted long-term cardiorenal events and mortality on the basis of published, validated risk equations; however, these risk equations were not developed in populations with ucHTN or trHTN. Although models were generally assessed to be of good quality, models incorporated health-related quality of life and cost data from controlled hypertensive or non-hypertensive populations, rather than those with ucHTN and trHTN. A range of economic models were identified and considered structurally relevant. These models demonstrated that treatment related improvements in blood pressure were cost-effective and robust in scenario analysis. However, important model limitations include their lack of use of population-specific health-related quality-of-life data and risk equations which may result in underestimation of treatment cost effectiveness. To reduce uncertainty and support improved economic modelling that can accurately contextualize emerging therapies for ucHTN and trHTN, future economic model analyses in ucHTN and trHTN need appropriate population health and cost data for these underserved populations.

Aim: This study aimed to project the epidemiology of chronic kidney disease (CKD) and its economic impact in Taiwan from 2022 to 2027 using a microsimulation model.Methods: A virtual representative population of Taiwan was generated using demographic data. The cohort then underwent annual progression using a validated patient‐level microsimulation technique, projecting CKD onset and progression based on various factors, including age, sex, eGFR, and urine albumin level. The model also incorporated associated comorbidities like type 2 diabetes mellitus and hypertension and complications such as heart failure, myocardial infarction, and stroke. Healthcare costs associated with diagnosed CKD and kidney replacement therapy (KRT) were also projected.Results: In 2022, an estimated 10.6% of the total population (2.5 million individuals) in Taiwan were affected by documented or undiagnosed CKD. Without changes in care standards, this prevalence is projected to rise to 12.4% (3.0 million individuals) by 2027, a relative increase of 17.1%. The prevalence of KRT is expected to grow by 7.0% from 2022 to 2027. Complications related to CKD, including heart failure, myocardial infarction, and stroke, are also projected to increase. The annual healthcare costs for diagnosed CKD and KRT are anticipated to rise by 19.7% from TWD $51.96 billion in 2022 to TWD $62.18 billion in 2027.Conclusion: The projections underscore the escalating burden of CKD in Taiwan, emphasising the need for proactive strategies focusing on early diagnosis, effective management, and public awareness to mitigate the disease's socioeconomic impact.

Introduction Anemia is a common comorbidity of chronic kidney disease (CKD) that has been associated with increased risk of complications, healthcare expenditure, and reduced quality of life. In China, the treatment of anemia of CKD has been reported to be suboptimal in part because of a lack of awareness of the condition and its management. It is therefore important to raise awareness of the condition by estimating the future health and economic burden of anemia of CKD and also to understand how it may be addressed through proactive policies. This study aims to project the health and economic burden of anemia of CKD, in China, from 2023 to 2027 and to estimate the impact of a hypothetical intervention on related clinical and cost outcomes. Methods A virtual Chinese population was simulated using demographic, clinical, and economic statistics within a validated CKD microsimulation model. Each individual was assigned a CKD stage, anemia stage, comorbidity status (type 2 diabetes, hypertension), complication status (stroke, heart failure, and/or myocardial infarction), and a probability of receiving treatments and therapies. Annual direct healthcare costs were assigned and based on these factors. The hypothetical intervention reduced the prevalence of moderate and severe anemia by 5% annually. This hypothetical scenario was chosen to highlight the impact of implementing policies that could reduce anemia of CKD, and is aligned with the Healthy China 2030 policy, which aims to reduce mortality from noncommunicable diseases by 30%. Interventions could consist of early screening and intervention to reduce the escalation of anemia from mild to moderate or severe. Results were compared with a baseline “no change” scenario which reflects current trends. Results The number of patients with moderate/severe anemia of CKD was projected to increase from 3.0 to 3.2 million patients, with associated costs increasing from ¥22.0 billion (B) to ¥24.4B between 2023 and 2027, respectively. Compared with the no change scenario, the hypothetical intervention reduced the prevalence of moderate and severe anemia of CKD, saving ¥3.9B in healthcare costs in 2027 (¥24.4B vs ¥20.6B, respectively). Conclusions Consistent with trends in CKD burden in China, the prevalence of anemia of CKD is projected to increase, leading to greater related healthcare costs. The introduction of healthcare interventions designed to screen for and treat anemia more effectively could therefore reduce its future burden and related costs.

Correction to Declared competing interests of authors.

Background: Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m²] have an increased risk of comorbidities and psychological, social and economic consequences.Objectives: Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment.Data sources: Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017).Review methods: Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m². Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000–30,000.Results: A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [–20.23 kg, 95% confidence interval (CI) –23.75 to –16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of –4.41 kg (95% CI –5.93 to –2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit.Limitations: Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken.Conclusions: Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends.Future work: Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions.Study registration: This study is registered as PROSPERO CRD42016040190.Funding: The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.

Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) in England. Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline ‘no change’ scenario; (2) individuals’ pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM_2.5 and NO₂; (3) PM_2.5 and NO₂ concentrations reduced by 1 μg/m³; and (4) NO₂ annual European Union limit values reached (40 μg/m³). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM_2.5 and NO₂ combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM_2.5 and 573,363 diabetes cases estimated to be attributable to NO₂ by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data. Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM_2.5 and NO₂ stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure–response functions, as well as to disaggregate results by socioeconomic status.