How Can Digital Twins Support the Economic, Environmental, and Social Sustainability of Healthcare Systems: A Systematic Review Focused on the Triple Bottom Line

Digital twins (DTs) are transforming healthcare systems (HSs) by enabling real-time, data-driven decision-making. Despite their potential, research on DTs’ role in long-term HS sustainability remains nascent. This study systematically reviews DT use cases in HSs through the lens of the triple-bottom-line framework of sustainability, identifying their economic, environmental, and social contributions. Additionally, it maps these use cases to the United Nations (UN) Sustainable Development Goals (SDGs) to assess their alignment with global sustainability policies. A systematic literature review following the PRISMA framework was conducted across four databases (Scopus, Web of Science, Engineering Village, and PubMed), identifying 81 peer-reviewed studies. DT use cases were categorized into sustainability dimensions and qualitatively mapped to UN SDGs. We identify 28 unique DT use cases supporting HS sustainability – 13 contributing to economic (e.g., precision medicine, early diagnosis), 8 to environmental (e.g., energy-efficient hospital operations, waste management), and 7 to social sustainability (e.g., provider burnout prevention, equitable access). Our mapping reveals that DTs could support 11 of 17 UN SDGs, including SDG 3 (good health and well-being), SDG 8 (economic growth), SDG 9 (innovation), and SDGs 12–15 (environmental impact mitigation), among others. This study documents the significant potential of DTs to enhance HS sustainability across economic, environmental, and social dimensions while supporting multiple SDGs. However, most existing DT studies overlook explicit sustainability linkages, with limited attention to assessing or prioritizing DTs’ impact on HS sustainability. Future research should develop standardized sustainability metrics, conduct empirical studies, and create frameworks linking DT outcomes to SDGs.