Tactical Combat Casualty Care Training in the U.S. Military: A Comparative Cost Assessment Between Virtual Reality Simulation and Traditional Simulation.

INTRODUCTION: As operational medicine grows in complexity, military units need novel solutions to optimize an ever-increasing training burden and associated costs. Tactical Combat Casualty Care (TCCC) training courses using manikins are resource intensive and difficult to scale. Prior studies demonstrate comparable learning outcomes for virtual reality (VR)-based medical training and traditional medical simulation for selected cognitive and procedural domains, supporting VR's evaluation as a potentially cost-efficient and time-efficient training modality. To address a lack of standardized cost comparisons, a direct per-learner cost and time-efficiency analysis of VR versus manikin-based simulation was performed for a standardized TCCC capstone scenario. MATERIALS AND METHODS: Annual (2024) cost and operational data from a military medical simulation training site were analyzed using a direct per-learner, per-scenario comparison of VR and manikin-based simulation for a single TCCC Level II capstone scenario. Capital and maintenance costs were annualized and allocated proportionally based on platform utilization to isolate the capstone-attributable share of total platform expenditures. Per-learner costs and total class time were calculated descriptively and projected over a 3-year period using constant pricing and throughput assumptions. RESULTS: Under a utilization-based incremental cost model, per-learner capstone costs for VR simulation were approximately 90% lower than for manikin-based simulation. When setup, execution, and teardown time were included, VR allowed an approximately 3.8-fold increase in modeled trainee throughput compared with manikin-based simulation. CONCLUSIONS: Under equivalent operational assumptions, VR simulation was associated with lower per-learner costs and reduced total class time for a standardized TCCC capstone scenario. These findings suggest that VR may serve as a scalable, cost-efficient and time-efficient option for scenario-based training in distributed and resource-constrained environments, while remaining complementary to manikin-based simulation for training activities requiring tactile psychomotor skill development.