ICU patients with healthcare-associated infections cost nearly four and a half times more in Türkiye

Patients treated in Turkish intensive care units who developed healthcare-associated infections faced dramatically higher costs and higher mortality than comparable patients who avoided infection, according to a retrospective matched cohort study published in Cost Effectiveness and Resource Allocation. The study, led by Fatma Gamze Malçok and Aliye Aslı Sonsuz, examined clinical and financial records from seven general ICUs in a high-capacity tertiary-level public-private hospital in Türkiye over a two-year period.

The researchers compared 90 patients with healthcare-associated infections against 180 matched controls, matched at a 1:2 ratio by age, sex, and primary admission diagnosis coded under ICD-10. Data came from infection surveillance records, the MEDULA billing system used between the Social Security Institution (SSI) and healthcare facilities, and the hospital’s information management system. The economic analysis captured direct medical expenditures recorded by the hospital and reimbursement amounts from the SSI payer perspective.

The clinical contrast was stark. Mortality among patients with HAIs reached 67.8 percent, compared with 32.8 percent among matched controls, a difference the authors report as statistically significant with p < 0.001. ICU length of stay also differed enormously: patients with infections spent a median of 57.0 days in the ICU, versus 9.0 days for controls, again with p < 0.001.

Expenditures were significantly higher in the HAI group across every category examined. The matched mean difference for laboratory services was USD 609.31 (95% CI: 501.19–721.90), for examination services USD 2,567.30 (95% CI: 2,046.36–3,118.91), for drug-related expenditures USD 3,004.26 (95% CI: 2,400.81–3,696.55), and for inpatient services USD 5,296.85 (95% CI: 4,113.76–6,593.37), with all comparisons reaching p < 0.001.

Reimbursement from the Social Security Institution followed the same pattern. The matched mean difference in SSI reimbursement was USD 9,495.26 (95% CI: 7,843.58–11,291.33; p < 0.001), meaning the insurer paid out substantially more for patients who acquired infections during their ICU stay.

To account for the skewed distribution of cost data, the researchers fitted an adjusted Gamma regression model. In that 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). Notably, age, sex, and baseline APACHE II score were not significantly associated with reimbursement, and reimbursement did not differ significantly according to the type of healthcare-associated infection.

The authors conclude that patients with HAIs had longer ICU stays, higher healthcare expenditures, and higher SSI reimbursement than matched controls, and they frame the results as real-world evidence of the economic implications of HAIs in ICU care in Türkiye. They also caution that future studies incorporating infection onset timing and longitudinal resource use are needed to estimate HAI-attributable expenditures and to inform infection prevention and reimbursement policies.

That caveat matters for interpretation. Because the study is a retrospective single-hospital matched cohort analysis, it documents associations between infection status and costs within this setting rather than a precisely isolated causal effect of infection itself, and the authors note that estimating truly attributable expenditures requires further work with infection onset timing built into the design. The study was published open access on 24 October 2026, and the version shared carries a permanent DOI as an accepted, citable article subject to further editorial edits before the final Version of Record.

Subject of Research: Healthcare expenditures and reimbursement for intensive care patients with healthcare-associated infections in Türkiye

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

Article References: Malçok, F. G., & Sonsuz, A. A. (2026). Healthcare expenditures and reimbursement among patients with healthcare-associated infections in intensive care units: a retrospective matched cohort study in Türkiye. Cost Effectiveness and Resource Allocation. https://doi.org/10.1186/s12962-026-00844-8

Image Credits: AI Generated

DOI: 10.1186/s12962-026-00844-8

Keywords: healthcare-associated infections, intensive care units, healthcare expenditures, reimbursement, Social Security Institution, Türkiye, retrospective cohort study, ICU length of stay, mortality, cost analysis, Gamma regression, infection prevention