Healthcare expenditures and reimbursement among patients with healthcare-associated infections in intensive care units: a retrospective matched cohort study in Türkiye

Abstract

Abstract Objective To compare healthcare expenditures and Social Security Institution (SSI) reimbursement amounts between intensive care unit (ICU) patients with and without healthcare-associated infections (HAIs) and to examine associated factors. Methods This retrospective matched cohort study examined the clinical and financial data of 90 patients with HAIs and 180 controls from seven general ICUs in a high-capacity tertiary-level public-private hospital in Türkiye over a two-year period. The case and control groups were matched at a 1:2 ratio according to age, sex, and primary admission diagnosis (ICD-10). The economic analysis considered direct medical healthcare expenditures recorded by the hospital and reimbursement amounts from the SSI payer perspective. We used surveillance data, MEDULA (healthcare billing system between SSI and healthcare facilities), and a hospital information management system. Results Patients with HAIs had higher mortality (67.8% vs. 32.8%; p < 0.001) and longer ICU length of stay (median: 57.0 vs. 9.0 days; p < 0.001) than matched controls. Healthcare expenditures were significantly higher in the HAI group for laboratory services (matched mean difference: USD 609.31; 95% CI: 501.19–721.90), examination services (USD 2,567.30; 95% CI: 2,046.36–3,118.91), drug-related expenditures (USD 3,004.26; 95% CI: 2,400.81–3,696.55), and inpatient services (USD 5,296.85; 95% CI: 4,113.76–6,593.37) (all p < 0.001). SSI reimbursement was also higher in the HAI group (matched mean difference: USD 9,495.26; 95% CI: 7,843.58–11,291.33; p < 0.001). In the adjusted Gamma regression model, SSI reimbursement among patients with HAIs was approximately 4.46 times that of matched controls (exp[B] = 4.460; 95% CI: 3.653–5.447; p < 0.001). Age, sex, and baseline APACHE II score were not significantly associated with SSI reimbursement, and reimbursement did not differ significantly according to HAI type. Conclusions Patients with HAIs had longer ICU length of stay, higher healthcare expenditures, and higher SSI reimbursement than the matched controls. These findings provide real-world evidence of the economic implications associated with HAIs in ICU care in Türkiye. Future studies incorporating infection onset timing and longitudinal resource use are needed to estimate HAI-attributable expenditures and inform infection prevention and reimbursement policies.

The authors' abstract, as published at the source. Cost Effectiveness and Resource Allocation, 2026 · DOI ↗