Abstract
Background With mounting economic burdens of diabetes and its complications, its implications on dental cost are not well studied. Diabetes has been established as an important risk factor for periodontal disease and subsequent tooth loss, but surprisingly few longitudinal studies have examined the relationship between diabetes and dental care costs. ObjectiveTo evaluate associations between diabetes and costs of dental care from a 5-year prospective observation of the insured with and without diagnosed diabetes.
Methods/Research Design This was a cohort analysis using linked data from Washington Dental Service and Group Health Cooperative on enrollees continuously and dually insured from 2002–2006. Adults with and without diabetes were matched on baseline characteristics using propensity scores and then compared on 5 years of follow-up dental costs.
Results Of the 49,023 linked enrollees that met the study inclusion criteria, 4,038 (8.24%) enrollees met criteria for diabetes. Post matching results show that adults with diabetes had 3% lower attendance to a dentist compared to the matched controls (P < 0.001). Among those with a dental visit, diabetes patients were costlier than the control group in non-surgical periodontal procedures, extractions and removable prosthetics (P < 0.001 for all) and were less expensive in diagnostic, preventive and restorative (fillings and crowns) procedures (P < 0.001 for all). There was no significant difference in total dental care cost between the two groups.
Conclusions Despite the lack of difference in total cost for dental care, the distribution of costs across procedure-classes was significantly different for patients with diabetes with higher emphasis on tooth replacing procedures than tooth-retaining procedures. In an administrative services-only arrangement with indemnity and PPO plans, the improved utilization of preventive dental care could accrue cost savings to patients and employers through reduction in downstream costs related to intensive procedures and in indirect costs related to lost productivity and time.
