A stochastic cost–benefit analysis tool for estimating the economic and time savings of mediation in medical malpractice disputes

Medical malpractice disputes can impose substantial economic and time burdens on healthcare systems and patients. Mediation has been proposed as a less adversarial alternative to litigation that is cost and time efficient. We developed a user-friendly, freely available R/Shiny application that uses stochastic simulation to project the net present value (NPV) of monetary savings and aggregate case-resolution time savings from the adoption of a mediation strategy relative to an all-trial comparator. Under the specified assumptions, projected monetary and time savings were positive in all three scenarios. In the high-income scenario, applying the mediation strategy to 2,000 eligible claims annually over 10 years produced mean NPV savings of US$114.08 million (95% simulation interval [SI] US$81.15–149.36 million) and mean time savings of 13,204 court-years (the sum of case-resolution years avoided across claims; 95% SI 9,733–16,661). Corresponding mean savings in the middle- and low-income scenarios were US$47.77 million and US$13.64 million, with 15,864 and 12,611 court-years saved, respectively. The tool allows stakeholders and policymakers to explore potential savings using locally relevant cost, duration, mediation-resolution rates, and conditional-success assumptions. Clinical trial number: Not applicable.