Medco Study Reveals Pediatric Spending Spike on Drugs to Treat Behavioral Problems-77 Percent four-year Spending Rise Linked to Increased Use and Medicine Costs
May 17, 2004

ORLANDO, Fla., May 17, 2004 /PRNewswire-FirstCall via COMTEX/ -- Spending on drugs primarily used to treat attention deficit hyperactivity disorder (ADHD) surged 369 percent for children under age 5 as the number of kids taking one or more prescription medicines to treat behavior-related conditions hit nearly 9 percent for those children taking as least one medication overall, according to new data released today at the Medco Health Solutions, Inc. 2004 Drug Trend Symposium.

"This analysis provides a striking commentary on the state of pediatric treatment in this country, as well as the costs shouldered by parents whose children live with these conditions," said Dr. Robert Epstein, chief medical officer, Medco. "It goes without saying that early detection and appropriate treatment of these conditions is extremely important, but the emphasis is on 'appropriate' with an eye on cost-effective therapy, as well."

The research reviewed the prescription data of 300,000 children ages 19 and younger in four major categories of behavioral medications used to treat a variety of conditions including ADHD, depression, autism and conduct disorders. Although recent studies have found an increase in the use of antidepressants, the Medco research found an even greater growth in the utilization of medications used to treat other behavioral conditions.

Among the major findings of the analysis:
o Prescription drug spending for behavioral conditions rose 77 percent between 2000 and 2003 due to both increased costs and increased use of these medications.
o In 2003, spending on behavioral medications to treat children overtook both the antibiotic and asthma categories, which are traditionally high-use categories in pediatric medicine.
o The number of children on behavioral medications has jumped more than 20 percent between 2000 and 2003, outpaced only by the increase of children on drugs to treat gastrointestinal conditions, which increased by nearly 28 percent.
o Among the largest increases were medications primarily used to treat attention deficit/hyperactivity disorder (ADHD) -- where spending increased by 183 percent for children overall, and by 369 percent increase for children under age 5. Utilization in preschoolers was up 49 percent from 2000 to 2003.
o Spending on antidepressants for children grew 25 percent, while use of these drugs rose 27 percent between 2000 and 2003. A review of 2004 data shows that of the children on at least one prescription medication in the first quarter of this year, the number of children using antidepressants increased by 15 percent over the first three months of 2003.
o The number of children on medications to treat severe behavioral conditions related to autism and conduct disorders increased by more than 60 percent from 2000 to 2003, while spending on these drugs rose 142 percent in the pediatric group. Among children ages 5 through 9, utilization was up 85 percent, while spending in this category grew 174 percent.
o Although children continue to predominantly use antibiotics, allergy and asthma drugs, the rate of increase in utilization and cost for these categories has been more moderate over the past four years than for behavioral medications; antibiotics showed no change in utilization and a 24 percent increase in spending; the use of allergy treatments increased 3 percent, while spending decreased by 7 percent; and asthma medications showed a 12 percent increase in utilization and a 24 percent rise in costs.

Pediatric Drug Trend - A Window into Future Costs
Medco's annual Drug Trend Report examines the drug spending experience representative of its more than 60 million members to help identify factors that contribute to the rising costs of prescription drug care. The total number of dollars vested in prescription medications for patients under age 19 remains a relatively modest percentage compared to other age groups, however the rate of increase in spending was significant -- an indicator of future trends.

Surprisingly, the average unit cost per child per day is more than 60 percent higher than that of seniors. Although children take fewer medications than seniors, medications used by children have the highest average cost -- $2.12 per day for children versus $1.29 per day for seniors.

"The unit costs of medications for children outweigh that of all other age groups, so we have made it a priority to help our clients understand the factors that drive pediatric drug trend, and offer solutions to those challenges," said Epstein. "Through education and encouraging appropriate medication use, plans can help curb the explosive trend in the pediatric population."

Medco's analysis uncovered additional drug trend drivers in the pediatric market:
o Biotech/specialty medications spending highest among pediatrics: Only a very small proportion of children are prescribed specialty medications, although there has been significant growth in this area.
o Select biotechnology drugs contribute a larger portion of overall drug spending among children than any other age group. Among children, spending growth from 2000 to 2003 was greatest for select biotechnology medications (127 percent) and rheumatological therapies (44 percent) within the specialty area. Additionally, one of the key cost drivers in the asthma category was Xolair, a new biotech medication to treat asthma in children 12 years and older.
o Diabetes treatment rising more slowly: Spending on diabetes therapies increased by only 7 percent, a significantly lower annual rate of increase than 2002 (20 percent) and 2001 (23 percent). Diabetes therapy utilization fell 3 percent in 2003, following three consecutive years of growth potentially reflecting a move toward lifestyle changes such as diet and exercise as first a line course of therapy.
o Gastrointestinal medications continue growth among infants: Spending on ulcer and acid-reflux medications for children younger than five years old rose 26 percent last year. The class continues to be one of the fastest growing segments of drugs among the pediatric age group perhaps related to the new treatment indications for these medications in children age 2 and older.