BMJ Qual Saf doi:10.1136/bmjqs-2011-000191
  • Narrative review

Economic evaluation in patient safety: a literature review of methods

  1. Philippe Michel1
  1. 1Centre de coordination de l'évaluation clinique et de la qualité en Aquitaine (CCECQA), Hôpital Xavier Arnozan, Avenue du Haut-Lévêque, 33600, Pessac, France
  2. 2Institut de recherché et documentation en économie de la santé (IRDES), 10, rue Vauvenargues, 75018, Paris, France
  1. Correspondence to Dr Bruna Alves de Rezende, Centre de coordination de l'évaluation Clinique et de la qualité en Aquitaine (CCECQA), Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 33600, Pessac, France; bruna.alves_msp{at}
  1. Contributors Bruna Alves de rezende is the corresponding author. She did the literature search and article selection and initial analysis. She conceived, structured and filled out the template used for summarising the selected articles. She was responsible for the final redaction of all the versions of the paper. She was also in charge of the redaction of part of the responses to the referees and to the editor's comments. Zeynep Or played an important part in article selection and initial analysis. She revised all of the information in the analysis template used by the authors. She widely contributed to the revision of the first and subsequent versions of the paper and was in charge of writing part of the responses to the referees' and editor's comments. Laure Com-Ruelle contributed to structuring the analysis template and to the analysis of the selected articles. She also contributed to revising the first and subsequent versions of the paper. Philippe Michel contributed to the analysis of the selected articles and revised the first and the subsequent versions of the paper. He widely contributed to rewriting of some sections. He was also in charge of writing part of the responses to the referees' and the editor's comments.

  • Accepted 7 December 2011
  • Published Online First 6 March 2012


Patient safety practices, targeting organisational changes for improving patient safety, are implemented worldwide but their costs are rarely evaluated. This paper provides a review of the methods used in economic evaluation of such practices. International medical and economics databases were searched for peer-reviewed publications on economic evaluations of patient safety between 2000 and 2010 in English and French. This was complemented by a manual search of the reference lists of relevant papers. Grey literature was excluded. Studies were described using a standardised template and assessed independently by two researchers according to six quality criteria. 33 articles were reviewed that were representative of different patient safety domains, data types and evaluation methods. 18 estimated the economic burden of adverse events, 3 measured the costs of patient safety practices and 12 provided complete economic evaluations. Healthcare-associated infections were the most common subject of evaluation, followed by medication-related errors and all types of adverse events. Of these, 10 were selected that had adequately fulfilled one or several key quality criteria for illustration. This review shows that full cost–benefit/utility evaluations are rarely completed as they are resource intensive and often require unavailable data; some overcome these difficulties by performing stochastic modelling and by using secondary sources. Low methodological transparency can be a problem for building evidence from available economic evaluations. Investing in the economic design and reporting of studies with more emphasis on defining study perspectives, data collection and methodological choices could be helpful for strengthening our knowledge base on practices for improving patient safety.


  • Funding This research project was partly funded by DREES (Direction de la recherche, des études, de l'évaluation et des statistiques), the Evaluation and Statistics Department of the French Ministry of Health.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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