Economic evaluations of hypertension interventions in pregnancy lack standardisation: results of a systematic review.

OBJECTIVES: Hypertensive disorders of pregnancy (HDP), including pre-eclampsia, pose lifelong health risks for women and infants. While HDP interventions are increasingly evaluated for cost-effectiveness, methodological challenges and heterogeneity between studies exist. This systematic review examines how economic evaluations have been conducted, focusing on methodology, outcome measurement, perspectives, time horizons, and cost-effectiveness conclusions. METHODS: Following PRISMA 2020 guidelines, we searched Medline, Embase, EconLit, and Web of Science from inception to 31 December 2024 for cost-effectiveness, cost-utility, cost-benefit, cost-consequence, and cost-minimisation analyses of HDP interventions. Searching was updated on 4 November 2025. Data on costs, outcomes, and methodology were extracted. Reporting quality was evaluated using CHEERS 2022. RESULTS: Thirty-five included studies covered interventions from prevention to management. One-third of cost-effectiveness and cost-utility studies reported only women's outcomes. Among those capturing maternal and infant outcomes, over half estimated cost-effectiveness using outcomes for only one party. The remainder generated results for mothers and infants but using different approaches. Long-term maternal cardiovascular risks and infant outcomes were rarely extrapolated. Most studies adopted healthcare perspectives. Screening, prevention, and diagnostic interventions were frequently cost-effective, whereas evidence for treatment and management strategies was mixed. Most studies reported cost per pre-eclampsia case averted; fewer applied generic measures limiting comparability. CONCLUSIONS: Economic evaluations of HDP interventions face methodological challenges, particularly in capturing joint maternal and infant impacts. Furthermore, future studies should utilise adequate time horizons, wider perspectives, and generic health outcomes, to ensure cost-effectiveness evidence captures the full value of HDP interventions and informs policies optimising maternal and neonatal health.