A Cost–Benefit Analysis tool for the economic and time savings of mediation in medical malpractice disputes

A Cost–Benefit Analysis tool for the economic and time savings of mediation in medical malpractice disputes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Cost–Benefit Analysis tool for the economic and time savings of mediation in medical malpractice disputes Olympia Lioupi, Polychronis Kostoulas, Konstadina Griva, Charalambos Billinis, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8246633/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Medical malpractice disputes often impose significant economic and time burdens on healthcare systems, patients, and providers. Mediation is a promising, efficient and cost-effective alternative to litigation. Our objective was to develop a quantitative tool that quantifies the economic and time savings associated with the adoption of mediation in medical malpractice cases. We created a user-friendly, freely available R/Shiny application to estimate the net present value (NPV) of monetary and time savings from mediation versus traditional litigation. Substantial economic and time savings were projected across all scenarios. In high-income countries, a decade of implementing mediation for 2,000 annual claims yielded an estimated NPV of €115.22 million (95% CrI €81.73–€149.27 million) and 13,349 court-years saved. Corresponding savings for middle- and low-income countries were €47.97 million and €13.77 million, with 16,052 and 12,705 court-years saved, respectively. The tool enables interested stakeholders and policymakers to quantify the benefits of medical mediation under different settings as its flexible structure allows users to define their own input distributions and assumptions according to local policy and legal contexts. Health Law Health Policy Health Economics & Outcomes Research medical mediation cost–benefit analysis medical malpractice stochastic simulation Figures Figure 1 Figure 2 Figure 3 Figure 4 Full Text Additional Declarations The authors declare no competing interests. Supplementary Files CBAmanuscriptsupplRSQ.docx Supplementary Material Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8246633","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":597351835,"identity":"d90d833f-af56-44d2-806a-031bac996ef5","order_by":0,"name":"Olympia Lioupi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAp0lEQVRIiWNgGAWjYDACdsYGICkhx8DAQ6wWZogWYwY24rVAqMQGorXwMzM3PubdYZG+4X7vAcave4jQItnM2GzMe0Yid8MxvgRmmWdEaDE4zNgmzdsG0sJjwCxxgAQt6QYka0kAaWH8QIwWkF8M556RMJx5LMfgMAMxWvjZ2x8+eLujTp7v8BnDhz+I0QIG4NgEgsNExyZcC+MPorWMglEwCkbBSAIA8iQxakfrRngAAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0004-0821-0747","institution":"Faculty of Public and One Health, School of Health Sciences, University of Thessaly, Greece","correspondingAuthor":true,"prefix":"","firstName":"Olympia","middleName":"","lastName":"Lioupi","suffix":""},{"id":597356973,"identity":"d33c7dc2-c636-46ca-8735-04a9dbf6fa25","order_by":1,"name":"Polychronis Kostoulas","email":"","orcid":"https://orcid.org/0000-0001-7051-1541","institution":"Faculty of Public and One Health, School of Health Sciences, University of Thessaly, Greece","correspondingAuthor":false,"prefix":"","firstName":"Polychronis","middleName":"","lastName":"Kostoulas","suffix":""},{"id":597356974,"identity":"1dce6af9-a7d4-447b-a8b3-8265e5fae45e","order_by":2,"name":"Konstadina Griva","email":"","orcid":"https://orcid.org/0000-0001-8173-5663","institution":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore","correspondingAuthor":false,"prefix":"","firstName":"Konstadina","middleName":"","lastName":"Griva","suffix":""},{"id":597356975,"identity":"998300ac-c69a-4e3c-9adc-a64079323bd6","order_by":3,"name":"Charalambos Billinis","email":"","orcid":"https://orcid.org/0000-0002-2209-9772","institution":"Faculty of Public and One Health, School of Health Sciences, University of Thessaly, Greece","correspondingAuthor":false,"prefix":"","firstName":"Charalambos","middleName":"","lastName":"Billinis","suffix":""},{"id":597356976,"identity":"63b6c160-f09a-4730-a83e-cf4f4fe2866d","order_by":4,"name":"Costas Tsiamis","email":"","orcid":"","institution":"Faculty of Public and One Health, School of Health Sciences, University of Thessaly, Greece","correspondingAuthor":false,"prefix":"","firstName":"Costas","middleName":"","lastName":"Tsiamis","suffix":""}],"badges":[],"createdAt":"2025-12-01 06:23:16","currentVersionCode":2,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8246633/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-8246633/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105418061,"identity":"56b07b93-5268-4775-876a-884b014d6ad2","added_by":"auto","created_at":"2026-03-25 19:39:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65922,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1. Stochastic input distributions for costs and durations of mediation and litigation. Histograms correspond to the triangular distributions that model uncertainty in the cost of mediation, cost of trial, duration of mediation, and duration of trial. Each distribution is defined by user-specified minimum, most likely, and maximum values\u003c/p\u003e","description":"","filename":"Fig1CBA.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8246633/v2/06b259d8e3add5064b39e908.jpg"},{"id":105418042,"identity":"8ebdc9f0-81d1-46b1-b4b7-f9c757f12668","added_by":"auto","created_at":"2026-03-25 19:39:49","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30530,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 2. Modeled uptake of mediation over a 10-year period. The proportion of cases entering mediation each year is modeled using a sigmoid function reflecting gradual adoption. The curve shown corresponds to the high-income scenario, with initial uptake of 15%, final uptake of 75%, and steepness parameter k = 1.0.\u003c/p\u003e","description":"","filename":"Fig2CBA.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8246633/v2/6ea3c674b6f1896b520aa475.jpg"},{"id":105418066,"identity":"5243c373-2af9-457b-a62f-81d31c3e5d60","added_by":"auto","created_at":"2026-03-25 19:39:59","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":33822,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3. Projected annual net present value (NPV) of monetary savings per 100 cases. Mean discounted monetary savings from mediation compared to litigation across a 10-year horizon. The solid line represents the mean estimate across 1,000 simulation runs, while the shaded region denotes the 95% credible interval (2.5th–97.5th percentiles). A 5% discount rate was applied.\u003c/p\u003e","description":"","filename":"Fig3CBA.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8246633/v2/8d25fd72cca7176754f80867.jpg"},{"id":105418054,"identity":"7bf19b0f-b466-4bb2-b872-4753d5bfb636","added_by":"auto","created_at":"2026-03-25 19:39:51","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":43484,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4. Annual time savings per 100 cases associated with mediation adoption. Expected reduction in total court months compared to traditional litigation across a 10-year horizon. The solid line shows the mean estimate across 1,000 simulation runs, and the shaded area represents the 95% credible interval. Time savings are not discounted.\u003c/p\u003e","description":"","filename":"Fig4CBA.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8246633/v2/7ff54d784a17fa2e9958771a.jpg"},{"id":105418070,"identity":"33582169-0598-40e9-b448-5579380aaecf","added_by":"auto","created_at":"2026-03-25 19:40:04","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":704040,"visible":true,"origin":"","legend":"","description":"","filename":"CBAmanuscriptRSQ.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8246633/v2_covered_cd28e783-6441-42b4-b6b4-a93a398109a4.pdf"},{"id":105418064,"identity":"c676510f-9d9b-4258-a369-b9a09241d94c","added_by":"auto","created_at":"2026-03-25 19:39:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":345042,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Material\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"CBAmanuscriptsupplRSQ.docx","url":"https://assets-eu.researchsquare.com/files/rs-8246633/v2/366b905505122c6f4deab1af.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eA Cost–Benefit Analysis tool for the economic and time savings of mediation in medical malpractice disputes\u003c/strong\u003e\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"medical mediation, cost–benefit analysis, medical malpractice, stochastic simulation","lastPublishedDoi":"10.21203/rs.3.rs-8246633/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8246633/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMedical malpractice disputes often impose significant economic and time burdens on healthcare systems, patients, and providers. Mediation is a promising, efficient and cost-effective alternative to litigation. Our objective was to develop a quantitative tool that quantifies the economic and time savings associated with the adoption of mediation in medical malpractice cases. We created a user-friendly, freely available R/Shiny application to estimate the net present value (NPV) of monetary and time savings from mediation versus traditional litigation. Substantial economic and time savings were projected across all scenarios. In high-income countries, a decade of implementing mediation for 2,000 annual claims yielded an estimated NPV of \u0026euro;115.22\u0026nbsp;million (95% CrI \u0026euro;81.73\u0026ndash;\u0026euro;149.27\u0026nbsp;million) and 13,349 court-years saved. Corresponding savings for middle- and low-income countries were \u0026euro;47.97\u0026nbsp;million and \u0026euro;13.77\u0026nbsp;million, with 16,052 and 12,705 court-years saved, respectively. The tool enables interested stakeholders and policymakers to quantify the benefits of medical mediation under different settings as its flexible structure allows users to define their own input distributions and assumptions according to local policy and legal contexts.\u003c/p\u003e","manuscriptTitle":"A Cost–Benefit Analysis tool for the economic and time savings of mediation in medical malpractice disputes","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2026-03-25 19:39:25","doi":"10.21203/rs.3.rs-8246633/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2025-12-11 08:50:10","doi":"10.21203/rs.3.rs-8246633/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"07c08e5b-7ff4-4742-b5c9-feb446848298","owner":[],"postedDate":"March 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":63563482,"name":"Health Law"},{"id":63563483,"name":"Health Policy"},{"id":63563484,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2026-02-18T08:25:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-25 19:39:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-8246633","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8246633","identity":"rs-8246633","version":["v2"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}