Healthcare access challenges, including long wait times, workforce pressures, and suboptimal care for non-surgical musculoskeletal disorders, (MSKDs) highlight the need for sustainable models of care and expanded roles for physiotherapists. Physiotherapy-led care models such as advanced practice physiotherapy (APP) have shown promising clinical outcomes, but their adoption remains limited in many countries. Considering the financial pressures in various jurisdictions worldwide, we will argue that the lack of health economic evidence limits the development and implementation of these innovative physiotherapy care models in low-, middle-, and high-income countries. This symposium will discuss why health economic evaluation is needed in our field and call for more investment in this evidence base globally.

The first presentation will address gaps in health economic evaluation within physiotherapy. While the body of clinical evidence supporting physiotherapy-led models of care is growing, economic evaluations remain scarce and almost exclusively conducted in high-income countries. The impact of the limited evidence will be discussed. Demonstrating the economic value of these models is among the key factors supporting their development and implementation, further highlighting the need for more health economic evaluation in our field. Evidence from health economic comparisons between APP and usual medical care for musculoskeletal disorders will be presented, as well as comparisons between different physiotherapy approaches, such as brief interventions versus multimodal physiotherapy.

The second presentation will provide a specific example of a health economic evaluation conducted alongside a randomized clinical trial. Increasingly, studies support the effectiveness of emergency department physiotherapy models of care. However, broader adoption remains challenging, as there is currently limited evidence on the cost-effectiveness of these models of care. We will present a three-month cost-utility analysis carried out in a Canadian emergency department, which aimed to assess the efficiency of two care models: physiotherapist-led and usual physician-led management. Challenges and opportunities related to economic evaluations using observed data will also be discussed.

The third presentation will broaden the lens to low and middle‑income countries, with a particular focus on Africa, where diverse health system structures, resource constraints, and workforce dynamics may shape the evolution of physiotherapy-led models of care. This section will examine opportunities, barriers, and priority areas for advancing physiotherapy and advanced practice roles on the continent, drawing on studies conducted in Nigeria and supported by evidence from Ghana. Building on this context, the presentation will also explore how economic evidence generated in high‑income countries can be strategically leveraged to support the development and implementation of physiotherapy-led models of care in low and middle‑income settings.

Overall, this symposium will synthesize current evidence across settings to demonstrate that health economic evaluation is a critical component for advancing physiotherapy-led models of care. By integrating findings from high- and low-income contexts, the session will highlight both the transferability and limitations of existing evidence. It will provide participants with a clearer understanding of how to design, interpret, and apply health economic evidence to support implementation and policy decisions, and conclude with a call for coordinated international efforts to strengthen this evidence base.

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