Cost-effectiveness of virtual emergency care models: A protocol for a systematic review

Background: The COVID-19 pandemic has accelerated the adoption of virtual care models in emergency medicine. While virtual emergency care has the potential to expand access, improve efficiency, and reduce costs, rigorous evaluation of its cost-effectiveness compared with traditional in-person emergency care is needed. Objective: This systematic review aims to comprehensively search the literature, critically appraise the evidence, and synthesize findings on the cost-effectiveness of virtual emergency care models compared to in-person emergency care. Methods: We will search PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, and Scopus from 2010 to February 2025 for economic evaluations that report both costs and effects comparing virtual and in-person emergency care models. Studies that compare multiple virtual interventions without an in-person care comparator will be excluded. Two reviewers will independently screen studies, extract data, and assess methodological quality and risk of bias using established quality assessment tools. Covidence software will be used to manage the screening and data extraction process. A narrative synthesis and quantitative meta-analysis of incremental cost-effectiveness ratios (ICERs) will be conducted if appropriate. Discussion: This review will provide a comprehensive evidence synthesis on the cost-effectiveness of virtual emergency care to guide clinical implementation, health policy, and future research. Findings will be highly relevant as virtual care becomes increasingly integrated into emergency care delivery in the aftermath of the COVID-19 pandemic. PROSPERO registration: CRD42025648218