Treatment costs for diabetes care are higher in Texas than other states

Sep 18 2009

The Texas Business Group on Health (TBGH), a non-profit business association, today released its annual report on the prevalence, cost and quality of care for Texans with Type 2 diabetes. The report includes information for key local markets across the state including Austin, Dallas, El Paso, Fort Worth/Arlington, Houston and San Antonio. Also included are state and national benchmarks that can help providers and employers identify better opportunities to serve the needs of their patients and employees. The complete report is available in electronic format on the TBGH and DFWBGH websites and may be downloaded free of charge.

"Unfortunately the findings indicate that once again treatment costs for diabetes care are higher in Texas than most of the nation and the number of diagnoses continues to increase at an alarming rate," said Marianne Fazen, president and CEO of TBGH and executive director of the Dallas-Fort Worth Business Group on Health, a member of TBGH. "While we'd like to think that the growing number of diagnoses is due to greater awareness of the problem stemming from advocacy efforts by the business community, much of the increase may be due to the impact of poor health and diet."

The Dallas-Fort Worth Business Group and its health care partners use the annual information for the Dallas and Fort Worth/Arlington areas for their community-wide diabetes care improvement initiative, called the Partnership for Peak Healthcare Performance, to help validate its physician performance ratings in the metroplex.

Texas continues to lag the nation in appropriate diabetes care

When it comes to the use of evidence-based medical care for Type 2 diabetes patients, such as A1c tests, cholesterol tests and eye exams, Texas continues to rank lower than the national averages. Only Austin exceeded the national average, with 78.9% of Type 2 diabetes patients receiving an A1c test in 2008, compared to 73.8% nationally. San Antonio had the lowest rate of A1c testing, with only 62.7% of Type 2 diabetes patients receiving this test, which is considerably lower than the year before when 67.7% were tested.

Prevalence of diabetes -- worsening epidemic or greater awareness?

In 2008, the number of patients diagnosed with Type 2 diabetes rose sharply across Texas, perhaps suggesting a worsening epidemic, but also greater awareness of diabetes risks and more aggressive diagnosing. The highest increase in prevalence was in El Paso, where 74% more individuals were diagnosed with Type 2 diabetes in 2008 than the year before. Other communities that also had relatively large increases in prevalence include Houston: 41%; Austin: 34%; and Dallas: 31%.

Severity greater than national average

Type 2 diabetes severity levels are higher in Texas than the nation as a whole, as measured by the number of Type 2 diabetes patient with two or more complications caused by diabetes or two or more co-morbidities, which are conditions indirectly related to diabetes, such as congestive heart failure, coronary artery disease, hypertension, hyperlipidemia and obesity.

Diabetes care in Texas costs more

The cost of treating commercially insured Type 2 diabetes patients in Texas hospitals in 2008, regardless of setting (inpatient, outpatient, emergency room), exceeded the national averages. In fact, inpatient charges were 20% higher than the national average of $52,730, and an 11% increase over Texas hospitals' 2007 inpatient charges of $56,765 per Type 2 diabetes patient. Houston had the highest hospital inpatient charges for Type 2 diabetes patients at $62,816 per patient, which is a 13% increase over the year before. The lowest cost market was Ft. Worth/Arlington where Type 2 diabetes inpatient charges were $52,243, which is a surprising 10% drop from the year before (2007).

Among the six Texas markets profiled, physician charges for office or clinic-based Type 2 diabetes care was highest in Dallas, at $6,992 per patient, nearly double the Texas average of $3,871 and twice the national average of $3,399.

Making matters worse -- patients aren't complying

Patient compliance (taking prescribed medications) and persistence (total length of time on therapy) in filling their insulin and anti-diabetes prescriptions in 2008 declined consistently month over month across all of the Texas markets profiled in this report. Type 2 diabetes patients in Fort Worth were least likely to continue filling their insulin prescriptions over the 12 month period. In El Paso, persistence was the lowest in (56%) for non-insulin anti-diabetic medications at Month 12, compared to San Antonio where persistence was highest at Month 12 (65%) among the markets profiled.

The Texas Type 2 Diabetes Report for 2009 helps TBGH fulfill its mission of helping Texas employers play an active and enthusiastic role in promoting cost-effective delivery of quality health care to the benefit of the community. The report was produced with assistance from sanofi-aventis U.S.