title: A literature-based economic evaluation of healthcare preventable adverse events in Europe.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Patient Safety, NHS Improvement, UK.
authors.forename: Taofikat B
authors.initials: TB
authors.lastname: Agbabiaka
authors.affiliation: Institute for Patient Safety, University Hospital Bonn, Bonn, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Lietz
authors.affiliation: Alicante-Sant Joan Health District, Consellería de Sanidad, Alicante, Spain.|Universidad Miguel Hernández, Elche, Spain.
authors.forename: José J
authors.initials: JJ
authors.lastname: Mira
authors.affiliation: Medical Directorate, NHS England, UK.
authors.forename: Bruce
authors.initials: B
authors.lastname: Warner
mesh_terms: D005062:European Union / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D019300:Medical Errors / Q000009:adverse effects* / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000191:economics; D061214:Patient Safety / Q000191:economics; D011320:Primary Health Care / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years
keywords: adverse event; disability-adjusted life years; economic evaluation; patient safety