Interpersonal violence refers to physical, sexual, or psychological attack or deprivation perpetrated by families or partners (e.g., child abuse and neglect, intimate partner violence, elder abuse) or in the community (e.g., assault by acquaintances or strangers, violence related to property crimes, and workplace violence).¹ Data on the cost of violence are essential for informed decision making regarding the future benefits of resources directed toward violence prevention. The average per-person financial value of avoided violence is a particularly important measure because it can be used in cost–benefit analysis to compare the average per-person cost of a prevention strategy (typically, a short-term financial cost to a specific payer) with the average per-person value of averted violence (typically, a long-term benefit that accrues to individuals, their associates, employers, and communities). A recent review highlighted that the difference between the lowest and highest per-victim valuation of averted sexual assault ($15,000 vs $103,000 in 2008 U.S. dollars) used among assessed violence prevention economic evaluations could mean the difference between concluding that a prevention strategy is economically beneficial or not.² This review sought to summarize original per-person estimates of the attributable cost of interpersonal violence to support public health research and decision making.

This review used publicly available data. In 2023, English-language peer-reviewed journal articles published in 2000–2022 with a focus on high-income countries³ and reporting original per-person average cost of interpersonal violence estimates were identified using index terms in multiple databases (Appendix Table [A]1, available online). Included studies reported attributable average per-person monetary valuations of violence on the basis of the original source data (e.g., financial transactions, survey data on willingness to pay to avert violence, online query system). Studies were excluded owing to incorrect focus (e.g., collective violence, no comparison between people with and without violence exposure to identify attributable cost), source data predominantly in years before 2000, or only hospital facility charges analyzed.

Violence types were classified using Centers for Disease Control and Prevention (CDC) categories,^4–6 including adverse childhood experiences (ACEs)—violence such as physical or sexual abuse as well as nonviolent adversity such as parental incarceration. Studies investigating only fatal violence (homicide) were separately assessed. Key study elements such as time horizon (period over which costs are measured) and cost perspective (e.g., societal, costs to multiple payers) were identified (Appendix Table [A]2, available online). These elements influence the magnitude of cost estimates, although this review did not attempt to assess quality nor prioritize among available estimates; other resources exist with a general discussion of cost of illness data and methods.^7–9 Cost estimates were extracted for concise presentation using each study’s most aggregated average per-person monetary estimate (e.g., medical plus lost work productivity), for the most recent study year, per injury outcome (e.g., moderate versus severe), with currency year assumed as the last data year if not reported. Cost estimates by violence type were summarized by timeline and payer’s perspective (e.g., hospitalization event-only healthcare payer cost). Foreign currency values were converted using July 1 data (www.xe.com), and all costs were inflated to 2022 U.S. dollars.¹⁰

Database searches identified 3,849 articles, and 6 more were identified during review (Figure 1). Title and abstract screening identified 178 articles, and 73 articles—each describing a separate study—met inclusion criteria. About 50% of analyzed studies addressed fatal violence costs, 66% had a focus on the U.S., 70% analyzed administrative cost data, 52% reported a societal cost perspective, 33% reported lifetime costs, 33% discounted future costs, and 70% assessed direct healthcare costs (Table 1). The range of monetary estimates by violence type was as follows:

Among 23 ACEs studies (Table 1), monetary estimates ranged from $390 for ACE-related annual healthcare out-of-pocket costs per U.S. adult with ≥3 ACEs¹¹ to $20.2 million for the lifetime societal economic burden of a U.S. child maltreatment fatality¹² (Figure 2A).^11–33

This review highlights the range of peer-reviewed estimates representing an average per-person attributable cost of interpersonal violence available to public health professionals to address questions related to the economic burden of violence or the cost effectiveness of violence-prevention strategies. This concise presentation is a novel effort to distill a complex data topic and improve the efficiency of violence prevention researchers and public health decision makers.

The primary value of this review is in systematically assembling the available data on per-person attributable cost of interpersonal violence estimates by violence-prevention category so that public health professionals can refer to this information in aggregate and understand where economic evidence for prevention already exists or could be improved. Ultimately, understanding the long-term and comprehensive cost of violence is necessary to understand the economic benefits of prevention.