Economic evaluation in healthcare implementation: a systematic review

Background Economic evaluations are critical for guiding resource allocation in healthcare but remain underutilized in implementation science. While implementation strategies such as training, infrastructure change and facilitation incur substantial costs, few studies assess their economic value. This systematic review synthesizes evidence on how economic evaluations have been applied to implementation efforts in healthcare since 2016. Methods We conducted a systematic review following PRISMA guidelines, registered in PROSPERO (CRD420251018265). Searches were performed in PubMed, Scopus, PsycInfo, PsycArticles and trial registries for studies published after April 2016. Eligible studies included economic evaluations embedded in healthcare implementation efforts. Data extraction covered study context, implementation strategies, economic methods and quality assessed using the Drummond checklist. Results From 5,729 screened records, 22 studies were included. Most originated from the United States, with others from Australia, Africa, Asia, Denmark, and one multicountry study. Training and education were the most common implementation strategies. Sixteen studies reported cost-only analyses, while six conducted full economic evaluations: three cost-effectiveness, one cost-utility analysis, one cost-benefit analysis, and one cost-minimization analysis. Standardized health outcome metrics were rarely used; only one study used DALYs and one study used life-years gained. Reporting of perspective, time horizon and cost categories was inconsistent, and implementation and intervention costs were not always clearly distinguished. Conclusion Economic evaluation in implementation science remains limited, dominated by descriptive cost studies with major methodological gaps. Without linking costs to outcomes, evidence provides little policy guidance on value for money. More rigorous, prospective economic evaluations are needed, including standardized metrics and clear reporting, to ensure implementation strategies are scalable, sustainable and relevant to healthcare decision-makers. Systematic Review Registration PROSPERO CRD420251018265.