Injury and Trauma Care Training in Global Health: A Scoping Review of Costs and Cost-Effectiveness Across Resource Settings

Abstract Introduction Injury is a leading cause of death and disability worldwide, with a disproportionate burden in low- and middle-income countries, where health resources are constrained and funding decisions are highly cost-sensitive. Injury and trauma care training programs have demonstrated their effectiveness in enhancing the capacity of care providers to treat injured patients, but evidence on their costs and cost-effectiveness remains limited and fragmented. This scoping review aims to map and summarise current literature on costs and cost-effectiveness of injury and trauma care training across different resource settings. Methods We conducted a systematic search on PubMed, MEDLINE Complete, Embase via Ovid, Web of Science, EconLit and Emcare. Papers published in English that reported implementation costs or cost-effectiveness of trauma care training programs were included. Cost data were converted and presented as USD 2024. Results Twenty-eight studies were included, predominantly in low- and middle-income countries. Implementation costs varied considerably, starting from USD 3.70 (Lay-First-Responder) to USD 1,433.5 (Advanced Trauma Life Support). Foreign instructor involvement was a particularly significant cost driver, accounting for 38-85% of total implementation costs in some programmes. Training-of-trainers and cascading models were effective in reducing costs, with savings of up to 28% per participant without compromising training quality. Most economic evaluations demonstrated favourable cost-effectiveness, though the evidence base was limited and disparate. Conclusions Several programs were proved cost-effective, and training-of-trainers and cascading models offer promising strategies to reduce costs and improve sustainability. However, included studies revealed notable inconsistencies and methodological weaknesses. Future research should prioritise more rigorous and standardised economic evaluations, particularly in high-burden regions, such as Southeast Asia and the Eastern Mediterranean, where evidence remains scarce.