Introduction: Integrated care is increasingly being adopted to address the complex needs of patients with cardiometabolic multimorbidity. However, it is unclear how to cost-effectively configure health service pathways for these patients. This study aimed to review and appraise decision analytic models (DAMs) used in economic evaluations of integrated care interventions for patients with cardiometabolic multimorbidity. Methods: We conducted a systematic search for peer-reviewed articles in eight electronic databases, published in English language until December 2023. Any study worldwide that used a decision-analytic model to conduct an economic evaluation of an integrated care model for patients with cardiometabolic multimorbidity was included. We summarised characteristics of the DAMs, integrated care models evaluated, diseases constituting multimorbidity, and critically appraised the quality of reporting of the economic evaluations using Philips (2006) checklist. Results: Out of 16 model-based assessments of the differences between alternative integrated care pathways, most studies (n=13, 81%) were cost utility analyses, focused on care for patients with hypertension and/or diabetes concordant multimorbidity (n=11, 69%). Most studies were conducted in high-income countries (n = 11, 69%). More than half (n = 10, 63%) of the studies used simulated Markov models, while only three studies used individual sampling (microsimulation) models. Few studies were explicit about their data validation approaches against local data, quality of data incorporated in the models, and internal and external consistency. Conclusion: Decision-analytic models investigating integrated care pathways for cardiometabolic multimorbidity should employ microsimulation to describe and incorporate repeated patient interactions with health care and multimorbidity outcomes in the economic evaluations. Consideration of uncertainty in data sources and model structure is also needed to provide robust conclusions. The study also highlighted the need for more economic evaluations using DAMs in low- and middle-income countries to evaluate integrated care models in the context of cardiometabolic multimorbidity.

The authors have declared no competing interest.

EW acknowledges funding support from the Wellcome Trust as part of a doctoral training grant [218462/Z/19/Z] at the University of Sheffield.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present work are contained in the manuscript