Propensity score matching assessment of direct medical charges for patients with healthcare-associated infections.

IMPORTANCE

Healthcare-associated infections (HAIs) represent a significant source of harm related to healthcare delivery and are associated with substantial costs. A more precise estimation of the economic burden imposed by these infections can assist healthcare providers and payers in justifying investments in prevention strategies.

OBJECTIVE

To quantify the direct economic burden of healthcare-associated infections and identify the specific types of HAIs that impose the greatest economic costs.

METHODS

This is a retrospective case-control study. We enrolled all inpatients with hospitalizations lasting three calendar days or longer (from January 2023 to December 2024) at a Grade A tertiary hospital in Shenzhen, China, and propensity score matching (PSM) was applied for analysis. Demographic/clinical characteristics and direct medical costs were extracted from the EMR-integrated data analytics platform. In contrast, HAI surveillance data and laboratory parameters were sourced from the real-time HAI monitoring system.

RESULTS

Following PSM, the HAI group had significantly higher median total hospitalization costs than the non-HAI group (USD 7,158 vs. USD 1,212; p < 0.001), with all 11 cost components differing-pharmaceuticals (USD 1,650 (95% CI: 1457, 1891)) and lab tests (USD 928 (95% CI: 859, 1,042)) as primary contributors. When stratified by HAI type, LRTIs were the most prevalent and exhibited the higher total charges difference (USD 9,597; 95% CI: 8,099 to 10,968). This difference was primarily driven by higher median charges for pharmaceuticals (USD 2,698; 95% CI: 1,019 to 7,156) and laboratory tests (USD 1,574; 95% CI: 776 to 3,194). Among all infection categories, CLABSIs were associated with the highest increase in laboratory test charges.

CONCLUSION

The HAI group incurred higher total hospitalization charges compared to the non-HAI group, with increases observed across all individual charge components, including pharmaceuticals and laboratory test charges, which were the primary drivers of the overall increase. Among the various types of HAIs, CLABSIs resulted in the highest laboratory charges, while LRTIs were identified as the most prevalent and demonstrated significantly increased direct medical charges.