Systematic Review of Nonmedical Costs of Firearm Injury

To evaluate the impact of firearm injury prevention programs and policies, it is important to characterize firearm injury costs. A prior review evaluated medical-specific firearm injury costs, but nonmedical societal costs have not been previously reviewed. This study explicitly reviews the nonmedical costs of both fatal and nonfatal firearm injury.

A systematic review of studies conducted from 2000 to 2023 in English reporting nonmedical costs of U.S. firearm injury in Embase, PubMed, the Cochrane Library, EconLit, JSTOR, and gray literature was performed. The methods, data quality, types of nonmedical costs, and the relationship between nonmedical and medical costs were extracted. Bias was assessed using a modified Newcastle-Ottawa Scale and synthesized on the basis of the SWiM (Synthesis Without Meta-analysis) guidelines.

Nineteen studies analyzing national, state, city, and individual costs were identified. Studies generally used modeling approaches (13 studies) to calculate costs, but 4 used a cohort approach, and 2 used a willingness-to-pay approach. Studies evaluated wide ranges of costs: medical, productivity, intangible (quality of life), criminal justice, and other costs. In studies evaluating both medical and nonmedical costs, nonmedical costs were much higher, with criminal justice costs being 1.5-3.9 times larger, productivity costs being 14-25 times larger, and intangible costs being 29-175 times larger than medical costs.

The literature on nonmedical costs is relatively underdeveloped, leading to wide ranges in results. Studies consistently show that nonmedical costs are in orders of magnitude larger than medical costs of firearm injury with total costs potentially in the millions of dollars per injury. More research on nonmedical costs of firearm injury will help quantify and clarify the magnitude of these costs as well as be used to understand the cost-savings of specific prevention policies or programs.