A literature-based economic evaluation of healthcare preventable adverse events in Europe

Int J Qual Health Care. 2017 Feb 1;29(1):9-18. doi: 10.1093/intqhc/mzw143.


Purpose: To establish from the literature, cost of preventable adverse events (PAEs) to member states of the Joint Action European Union Network for Patient Safety and Quality of Care.

Data sources: We searched MEDLINE, EMBASE and CINAHL for studies in Europe estimating cost of adverse events (AEs) and PAEs (2000-March 2016). Using data from the literature, we estimated PAE costs based on national 2013 total health expenditure (THE) data reported by World Health Organization and converted to 2015 Euros.

Study selection/data extraction: Information on type, frequency and incremental cost per episode or estimated cost of AEs was extracted. Total annual disability-adjusted life years (DALYs) resulting from PAEs in 30 EU nations were calculated using an estimate from a published study and adjusted for the percentage of AEs considered preventable.

Result of data synthesis: Published estimates of costs of AEs and PAEs vary based on the care setting, methodology, population and year conducted. Only one study was from primary care, the majority were conducted in acute care. Nine studies estimated percentage of THE caused by AEs, 13 studies calculated attributable length of stay. We estimated the annual cost of PAEs to the 30 nations in 2015 to be in the range of 17-38 billion Euros, total DALYs lost from AEs as 3.5 million, of which 1.5 million DALYs were likely due to PAEs.

Conclusion: The economic burden of AEs and PAEs is substantial. However, whether patient safety interventions will be 'cost saving' depends on the effectiveness and costs of the interventions.

Keywords: adverse event; disability-adjusted life years; economic evaluation; patient safety.

MeSH terms

  • European Union / statistics & numerical data*
  • Health Expenditures / statistics & numerical data
  • Humans
  • Medical Errors / adverse effects*
  • Medical Errors / economics*
  • Outcome Assessment, Health Care / economics
  • Patient Safety* / economics
  • Primary Health Care / statistics & numerical data
  • Quality-Adjusted Life Years*