Hutton, D. W., Lefler, T. W., Yang, D., Mai, S., Holtz, M., Zhang, H., Modi, H. S., Hillegass, W. B., Zimmerman, M., & Carter, P. M. (2026). Systematic Review of Non-Medical Costs of Firearm Injury. American journal of preventive medicine, 108276. Advance online publication. https://doi.org/10.1016/j.amepre.2026.108276
Abstract
Introduction
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 non-medical societal costs have not been previously reviewed. This study explicitly reviews the non-medical costs of both fatal and nonfatal firearm injury.
Methods
A systematic review of studies conducted from 2000-2023 in English reporting non-medical costs of U.S. firearm injury in Embase, PubMed, the Cochrane Library, EconLit, JSTOR as well as grey literature. The methods, data quality, types of non-medical costs, and the relationship between non-medical and medical costs were extracted. Bias was assessed using a modified Newcastle-Ottawa Scale and synthesized based on the SWiM (Synthesis without meta-analysis) guidelines.
Results
Nineteen studies analyzing national, state, city, and individual costs were identified. Studies generally used modeling approaches (13 studies) to calculate costs, but four used a cohort approach and two 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 non-medical costs, non-medical costs were much higher, with criminal justice costs being 1.5 to 3.9 times larger, productivity costs being 14 to 25 times larger, and intangible costs being 29 to 175 times larger than medical costs.
Discussion
The literature on non-medical costs is relatively under-developed, leading to wide ranges in results. Studies consistently show non-medical costs are orders of magnitude larger than medical costs of firearm injury with total costs potentially in the millions of dollars per injury. More research on non-medical 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.
Keywords
Economics, Firearm Injury