Published, peer-reviewed research challenges one of the most common objections to virtual simulation in healthcare education: that it is simply too expensive.
In a randomized healthcare simulation study, virtual simulation achieved comparable measured learning and performance outcomes to mannequin-based simulation, but with a very different economic result.
The reported cost-utility ratio was US $1.08 for virtual simulation compared with US $3.62 for mannequin-based simulation.1
That does not mean every virtual simulation is automatically 70% cheaper than every physical simulation.
It means that when cost was considered alongside measured educational utility, the virtual approach delivered the outcome at a substantially more favourable cost ratio.
Virtual simulation has a visible price.
There may be platform licences, hardware, implementation, content and support costs. Because those numbers often appear together on a proposal or procurement document, they are easy to identify.
The cost of physical simulation is usually distributed across many different budgets and resources.
A simulation laboratory may already exist. Equipment may already have been purchased. Faculty may already be employed.
But none of that makes a physical simulation session free.
Physical simulation can require:
So the economically useful question is not:
“How much does the virtual simulation cost?”
It is:
“What does it cost to provide effective simulation to every learner who needs it?”
The economic argument only matters if the education works.
Fortunately, the evidence base extends well beyond cost.
A systematic review and meta-analysis published in the Journal of Medical Internet Research examined 31 randomized and cluster-randomized studies involving 2,407 health-professions learners.2
Compared with traditional education, virtual reality produced significantly higher post-intervention knowledge scores. The researchers also reported a large effect on cognitive skills.
The certainty of evidence ranged from low to moderate, so this should not be interpreted as proof that every virtual simulation will outperform every conventional teaching method.
But it does challenge the idea that virtual simulation is simply a cheaper substitute for a better educational experience.
In some comparisons, it produces better outcomes.
This is a different comparison.
A 2024 meta-analysis examined 27 randomized controlled studies involving 1,480 participants and directly compared virtual simulation with mannequins or simulation involving real people.3
Across the pooled studies, the researchers found no significant overall difference in:
At first glance, “no significant difference” can sound unremarkable.
Economically, it is anything but.
If two simulation approaches can produce broadly comparable educational outcomes, cost, access, repeatability and scalability become part of the educational decision.
Healthcare organisations do not necessarily have to develop virtual simulation software themselves.
They can licence established simulation platforms, subscribe to content, use existing hardware, or commission specialised scenarios when required.
That means the appropriate comparison is the total cost of ownership and delivery.
Physical and virtual simulation have different cost structures.
Many physical simulation costs recur each time the training is delivered. Rooms have to be available. Equipment has to be prepared. Staff have to be present. Sessions have to be scheduled. Scenarios may need to be reset.
Virtual simulation also has costs, but a greater proportion of those costs can be distributed across repeated use.
Farra and colleagues provide a useful example.4
Their study compared virtual reality training with an equivalent live healthcare exercise.
Initially, the virtual option was more expensive:
| Training approach | Initial cost per participant | Cost after repeated use over three years |
|---|---|---|
| Virtual reality | US $327.78 | US $115.43 |
| Live exercise | US $229.79 | US $229.79 |
If the analysis had stopped at implementation, virtual reality would have looked like the more expensive choice.
Once the cost was spread across repeated delivery, the result changed substantially.
The virtual exercise fell to US $115.43 per participant, while the live exercise remained at US $229.79.4
This is one of the most important economic characteristics of reusable digital simulation.
The first learner and the thousandth learner do not necessarily cost the same amount to train.
Cost per learner is only one part of the equation.
Physical simulation is constrained by physical capacity.
There are only so many rooms, pieces of equipment, instructors and available hours.
When access is limited, practice is limited too.
Depending on the platform and implementation model, virtual simulation can allow learners to practise outside the timetable of a physical simulation laboratory and repeat activities without requiring a complete physical scenario to be recreated.
That matters because the educational value of simulation is not simply that a learner experiences a scenario once.
Practice, repetition and feedback are central to skill development.
A better economic measure is not simply cost per simulation. It is cost per learner, considered alongside the number of meaningful opportunities that learner receives to practise.
Physical simulation remains essential for many healthcare competencies.
There are skills that require tactile interaction, physical equipment, supervised performance and direct human communication.
Virtual simulation offers a different set of strengths.
It can provide repeated practice, standardised scenarios, safe exposure to difficult situations and access that is less dependent on a specific room being available at a specific time.
The more useful question is therefore not whether virtual simulation should replace physical simulation.
It is whether some learning can be delivered or reinforced virtually so that expensive and limited physical resources are reserved for the activities that genuinely require them.
Good evidence does not need exaggeration.
The studies above do not prove that every virtual simulation is cheaper, that every VR product improves learning, or that virtual simulation should replace every physical training environment.
The economic evidence is also less mature than the learning-outcomes literature.
A systematic review of cost analyses in healthcare simulation found considerable variation in how costs were identified and reported, and called for more rigorous and consistent economic evaluation.5
Simulation design, feedback, usability, instructional quality and alignment with the intended competency still matter.
Perhaps that is the wrong question.
We have peer-reviewed evidence that virtual simulation can improve knowledge and cognitive skills compared with conventional education.2
We have evidence that it can produce broadly comparable outcomes to physical simulation across major competency categories.3
And we have published economic studies showing that virtual approaches can achieve substantially more favourable cost utility and become increasingly economical when training is delivered repeatedly.14
So when someone says:
“We couldn't possibly afford virtual simulation.”
The evidence suggests a better response:
“Compared with what, across how many learners, and over how many years?”
It can be, particularly when repeated delivery and learner numbers are considered. One randomized cost-utility study reported a cost-utility ratio of US $1.08 for virtual simulation compared with US $3.62 for mannequin-based simulation. This is a 70.2% lower cost-utility ratio, not evidence that every virtual simulation is universally 70% cheaper.
A 2024 meta-analysis of 27 randomized controlled studies found no significant overall differences between virtual simulation and mannequin or real-person simulation for knowledge, procedural skills, clinical reasoning and communication skills.
Yes, in some comparisons. A health-professions systematic review and meta-analysis found improved post-intervention knowledge and cognitive skills when VR was compared with traditional education.
No. Organisations can licence commercially available simulation platforms and content. The relevant economic comparison is total cost of ownership and training delivery, not the cost of internally developing software.
Many physical simulation costs recur every time a session is delivered. Digital simulation can distribute software, content and implementation costs across repeated use and larger numbers of learners.