Health Care Costs of Firearm Injury Hospital Visits in the US.

Abstract

Importance: Firearm injury is a leading cause of mortality in the US. Contemporary firearm injury health care costs and characteristics of hospital visits can inform investment decisions on treatment and prevention strategies.

Objective: To estimate the total health care cost of new firearm injury hospital visits from 2016 to 2021 in the US.

Design, setting, and participants: This economic evaluation study via Monte Carlo simulation included data from the Arkansas, Florida, Maryland, Massachusetts, New York, and Wisconsin Healthcare Cost and Utilization Project State Inpatient and Emergency Department databases from 2016 to 2021. Children and adults with an inpatient or emergency department (ED) hospital visit for new firearm injuries were included. Data were analyzed from June 2023 to May 2025.

Exposures: Firearm-related inpatient or ED visits with new firearm injury International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes.

Main outcomes and measures: A Monte Carlo simulation used new inpatient and ED firearm injury visits in 6 sample states to estimate the national health care cost for the treatment of initial firearm injuries from 2016 to 2021. The simulation also used national inpatient data from the RAND Corporation for nonsample states. Costs were adjusted for inflation to 2024 US dollars. Costs to each body region were derived from the Injury Mortality Diagnosis Matrix classification scheme.

Results: The Monte Carlo analysis included 2400 simulations. Firearm injuries in the US led to an estimated 298 721 ED visits and 185 846 inpatient visits, with a total health care cost of $7.7 billion from 2016 to 2021. Inpatient admissions accounted for 93% of the cost, or $7.2 billion. Treatment for children younger than 18 years accounted for 9% of the cost, or $684 million. Annual ED and inpatient visits were both approximately stable from 2016 to 2019, at which point they grew by 42% and 40%, respectively, from 2019 to 2021. Annual total health care cost was also stable at approximately $1.2 billion until 2019, when cost began to grow to a peak of $1.6 billion in 2021. The mean (SE) ED visit cost was $1743 (4.5), and the mean (SE) inpatient admission cost was $38 879 (138.9). These costs remained stable annually over the sample period.

Conclusions and relevance: In this economic evaluation study, an increase in firearm injuries in the last 6 years paralleled an increase in costs from 2016 to 2021.