Making room for patients in economic evaluation: a commentary on current capacity and future directions.

Patient engagement, in which patients and their caregivers work together with research teams, can enhance the relevance, quality, and applicability of health research findings. While patient engagement has been successfully integrated into many areas of health research, its application within health economic evaluations remains limited. This commentary explores interest and strategies for patient engagement in economic evaluation, based on our work with 5 patient partners and 12 research centres affiliated with the Ontario Strategy for Patient-Oriented Research SUPPORT Unit (OSSU). We also piloted a co-production approach to develop practical tools and strategies for meaningful engagement. Both patient partners and OSSU centre representatives emphasized the need for clear guidance, targeted training, and sustained investment to enable scalable and equitable engagement in this complex area of research. Key barriers identified included a lack of plain-language resources, limited institutional capacity for facilitating patient partnerships, and the absence of centralized supports across OSSU research centres. Through a series of virtual meetings between patient partners, we co-created a visual flow diagram and a patient activity matrix to support engagement across key stages of economic evaluation. The engagement process was grounded in shared learning, respect for lived experience, and responsiveness to evolving priorities. Our work supports the growing literature on patient engagement in health economics and offers early evidence that co-developed tools can support inclusive, patient-informed economic evaluations. Our findings lay the groundwork for future efforts to create targeted and practical guidance on when and how to embed patient perspectives throughout the economic evaluation process, thereby contributing to more transparent, collaborative, and equitable health policy decision-making.