Advancing costing methodology in Health Professions Education: A state-of-the-art review and research agenda

Despite three decades of research, costing methodology in health professions education (HPE) remains fragmented, limiting the production of consistent, interpretable, and decision-relevant cost evidence. As HPE institutions face increasing pressure to allocate limited resources effectively, robust cost evidence is needed to support cost-conscious decision-making. This study synthesizes persistent methodological challenges in HPE costing and proposes a research agenda to support more transparent, interpretable, and contextually responsive methodology.

A state-of-the-art review was conducted to 1) chart key developments in HPE costing methodology, 2) synthesize recurring methodological challenges across contemporary cost literature, and 3) develop a research agenda. All publication types addressing costs of designing, developing, implementing, and evaluating HPE were eligible if they reflected methodological challenges in cost research. Challenges were synthesized across nine established phases of economic research: study design, perspective, time horizon, identification, measurement, valuation, reporting, comparability, and quality appraisal. Insights from the historical overview and synthesized challenges informed a research agenda.

Development of HPE costing methodology has progressed through two parallel streams: domain-specific frameworks and broader conceptual guidance. Limited integration across these approaches contributes to persistent fragmentation. Challenges were identified across all nine phases of cost research, including inconsistent cost definitions, difficulty separating educational and clinical costs, limited data sources, and limited operational guidance for identifying, measuring, valuing, and reporting costs. These findings informed a research agenda outlining priorities to support more transparent, interpretable, and contextually responsive costing methodology.

Methodological fragmentation in HPE cost research reflects not only uneven methodological development, but also the conceptual, structural, and operational complexities of examining costs across diverse HPE contexts. The resulting research agenda identifies priorities to strengthen methodological foundations through improved transparency, shared methodological resources, and context-sensitive application. Addressing these gaps may support production of rigorous, interpretable, and decision-relevant cost evidence in HPE.