• P J Cook, B A Lawrence, J Ludwig, and T R Miller.
• Sanford Institute of Public Policy, Duke University, Durham, NC 27708, USA. cook@pps.duke.edu
• JAMA. 1999 Aug 4;282(5):447-54.

ContextThe cost of treating gunshot injuries imposes a financial burden on society. Estimates of such costs are relevant to evaluation of gun violence reduction programs and may help guide reimbursement policies.ObjectivesTo develop reliable US estimates of the medical costs of treating gunshot injuries and to present national estimates for the sources of payment for treating these injuries.Design And SettingCost analysis using E-coded discharge data from hospitals in Maryland for 1994-1995 and New York for 1994 and from emergency departments in South Carolina for 1997. Other sources of data included the National Electronic Injury Surveillance System for 1994 incidence of nonfatal gun injuries, the National Spinal Cord Injury Statistical Center database for 1988-1992 estimates of lifetime medical costs of gun injuries, and the 1994 Vital Statistics census for incidence of fatal gun injuries.Main Outcome MeasuresEstimated national acute-care and follow-up treatment costs and payment sources for gunshot injuries.ResultsAt a mean medical cost per injury of about $17000, the 134445 (95% confidence interval [CI], 109465-159425) gunshot injuries in the United States in 1994 produced $2.3 billion (95% CI, $2.1 billion-$2.5 billion) in lifetime medical costs (in 1994 dollars, using a 3% real discount rate), of which $1.1 billion (49%) was paid by US taxpayers. Gunshot injuries due to assaults accounted for 74% of total costs.ConclusionsGunshot injury costs represent a substantial burden to the medical care system. Nearly half this cost is borne by US taxpayers.

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