ADHD Drug Spending Surges 369 Percent in Children Under Five - Commentary by Fred A. Baughman Jr., MD

ADHD Drug Spending Surges 369 Percent in Children Under Five

ORLANDO, Fla., May 17 /PRNewswire-FirstCall/ — 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.”

[Fred A. Baughman Jr., MD:
What is "detection" when ADHD has never been proved to be a physical
abnormality = disease =disorder. what is "appropriate
treatment" when ADHD is not a disease, i.e. when children said to have it are normal]

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:

– Prescription drug spending for behavioral conditions

[Fred A. Baughman Jr., MD:
not one an actual physical abnormality of the brain or body = disease]

rose 77 percent between 2000 and 2003 due to both increased costs and increased
use of these medications.

– 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.

– 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.

[Fred A. Baughman Jr., MD:
the increase of 28 % for GI conditions needs viewing with a skeptical eye also]

– 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.

– 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.

– The number of children on medications to treat severe behavioral conditions

[Fred A. Baughman Jr., MD:
they throw in the “severe” in hope this will convince someone it is real illnesses/diseases they speak of’]

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.

– 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.

[Fred A. Baughman Jr., MD:
here, for the most part we speak of real diseases = physical abnormalities, diagnosed
by examinations or tests/technologies that demonstrate the physical abnormalities.]

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:

– 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. 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.

– 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).

[Fred A. Baughman Jr., MD:
another real disease]

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.

– 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.

[Fred A. Baughman Jr., MD:
I suspect the majority in this class have no demonstrable disease, that this treatment too is largely unjustifiable.]

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.

2004 Drug Trend Symposium – Navigating the New Health Economy

The Medco 2004 Drug Trend Report, released at the company’s Drug Trend Symposium,
provides a comprehensive examination of the various factors that influenced
prescription drug spending in 2003, and a forward-looking view into the trends
that could shape prescription healthcare in the next three years. The Report
discusses independent and proprietary research, data and analysis, legislative
and regulatory change, advances in technology and new approaches to the management
of prescription healthcare services. More information about Medco’s Drug Trend
Report and Symposium is available at: http://www.drugtrend.com/

Source: Medco Health Solutions, Inc.