What is the clinical evidence from this study?

Study design: Systematic Review. Population: Uncontrolled and treatment-resistant hypertension (n=21). Intervention: Health economic models of pharmacological and renal denervation interventions. Primary outcome: Construct and quality of existing health economic modelling.

What does this research mean for the field?

While existing health economic models demonstrate that treatments for uncontrolled and treatment-resistant hypertension are cost-effective, they likely underestimate this value due to reliance on risk equations and quality-of-life data from non-specific populations. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To critically evaluate the construct, quality, and input parameters of existing health economic models assessing pharmacological and interventional management of uncontrolled and treatment-resistant hypertension.

June 1, 2026PharmacoEconomicsOpen Access

A Systematic Literature Review of Health Economic Modelling Approaches Used to Evaluate Treatment Resistant and Uncontrolled Hypertension: A Critical Appraisal and Considerations for the Design of Future Model Analyses

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Key result

Treating ucHTN and trHTN is cost-effective, though current economic models likely underestimate true cardiovascular value.

n=21

Why the study?

Uncontrolled and treatment-resistant hypertension increase cardiorenal events and mortality, requiring a critical appraisal of existing health economic models to inform future model design.

What are the construct and quality of existing health economic models evaluating treatments for uncontrolled and treatment-resistant hypertension?

Population

21 economic modelling studies assessing pharmacological or renal denervation interventions in ucHTN or trHTN

Comparison

Pharmacological or renal denervation interventions vs various comparators across included models

Design

Systematic literature review following PRISMA 2020

Authors

MFMatthew FranklinUniversity of Sheffield JFJames FotheringhamUniversity of Sheffield RTRod S TaylorUniversity of Glasgow

Discussion

Member takes

Implication

Supports cost-effectiveness of blood pressure control in resistant hypertension; extends models by underscoring need for disease-specific risk equations.

Key Points

To critically evaluate the construct, quality, and input parameters of existing health economic models assessing pharmacological and interventional management of uncontrolled and treatment-resistant hypertension.
Conducted a systematic review following PRISMA 2020 across Medline, Embase, EconLit, CEA Registry, and INAHTA from inception to May 2024 (updated February 2026), applying a 2005 onward selection limit.
Eligible studies evaluated pharmacological or renal denervation treatments for uncontrolled hypertension (BP over target on ≥1 antihypertensive) or treatment-resistant hypertension (BP over target on ≥3 antihypertensives including a diuretic) in adults aged ≥18 years.
Two reviewers independently screened records, extracted data, and evaluated study quality using the Drummond checklist.
Screening of 2754 deduplicated records identified 21 eligible modelling studies, comprising 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.
Models consistently demonstrated that treatment-related reductions in systolic blood pressure were cost-effective across scenario analyses, typically adopting a healthcare system perspective.
Current models relied on cardiorenal risk equations, health-related quality of life estimates, and cost inputs derived from controlled hypertensive or non-hypertensive populations rather than uncontrolled or treatment-resistant cohorts, potentially underestimating cost-effectiveness.

Study Design

Type

Systematic Review (n=21)

Structured PICO

What are the construct and quality of existing health economic models evaluating treatments for uncontrolled and treatment-resistant hypertension?

Population

21 health economic modelling studies evaluating pharmacological or renal denervation interventions for adults with uncontrolled or treatment-resistant hypertension.

Exposure

Pharmacological or renal denervation (RDN) interventions

Outcome

Construct and quality of existing health economic modelling used in the evaluation of management approaches for ucHTN and trHTN

Existing health economic models for uncontrolled and treatment-resistant hypertension show cost-effectiveness of treatments but are limited by the use of non-specific risk equations and quality-of-life data.

Limitations

Lack of use of population-specific health-related quality-of-life data and risk equations, which may result in underestimation of treatment cost effectiveness.
Reliance on clinical inputs from non-hypertensive and general hypertension populations likely underestimates the risk of cardiovascular events.
No models were identified that evaluated emerging pharmacotherapies despite the potential economic burden.
lack of use of population-specific health-related quality-of-life data and risk equations

Cite This Study

Franklin et al. (2026) conducted a systematic review in Uncontrolled and treatment-resistant hypertension (n=21). Health economic models of pharmacological and renal denervation interventions was evaluated on Construct and quality of existing health economic modelling. Health economic models for uncontrolled and treatment-resistant hypertension generally found blood pressure improvements to be cost-effective, though reliance on data from general populations likely underestimates cardiovascular risk and treatment value.

synapsesocial.com/papers/6a202f7b3ffd06246d29472e https://doi.org/10.1007/s40273-026-01625-0

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Implication

Supports cost-effectiveness of blood pressure control in resistant hypertension; extends models by underscoring need for disease-specific risk equations.

A Systematic Literature Review of Health Economic Modelling Approaches Used to Evaluate Treatment Resistant and Uncontrolled Hypertension: A Critical Appraisal and Considerations for the Design of Future Model Analyses

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

A Systematic Literature Review of Health Economic Modelling Approaches Used to Evaluate Treatment Resistant and Uncontrolled Hypertension: A Critical Appraisal and Considerations for the Design of Future Model Analyses

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider