Financial and non-financial return on investment in simulation-based training: A scoping review

Objective To explore how return on investment (ROI) in healthcare simulation-based education (SBE) is defined, measured, and reported. Background SBE is widely used to improve clinical competence, patient safety, and system readiness. However, its financial and non-financial ROI is inconsistently evaluated, limiting its strategic application. Design A scoping review was conducted to map existing evidence on ROI in healthcare SBE. Methods Scopus, CINAHL, PubMed, and Web of Science were searched using terms related to simulation and economic evaluation. Eligible studies addressed the financial, educational, or strategic value of healthcare simulation. Screening and full-text reviews were performed by multiple reviewers. Studies were included if they focused on simulation-based training in healthcare settings and reported financial or non-financial return on investment outcomes, while studies not addressing simulation or ROI were excluded. Results Sixty-eight studies published between 2006 and 2024 were included. Five thematic domains emerged: cost (83.8%), effectiveness (51.5%), efficiency (25%), development (20.6%), and implementation (2.9%). Studies reported on high- and low-fidelity simulations, cost-saving innovations such as 3D-printed or DIY models, and budgeting strategies. Most studies demonstrated positive economic or clinical outcomes, but few used structured ROI frameworks. Research from low- and middle-income countries and implementation-focused studies were limited. Conclusions Although SBE shows clear financial and educational value, ROI remains poorly standardized and often underreported. Future studies should adopt comprehensive ROI models and include diverse geographic settings to support strategic investment in simulation-based training.