In growing numbers, children across America are adding a dose of medicine to their daily routine. In 2009, drug trend for children – a measure of prescription spending growth – increased 10.8 percent, driven by a 5 percent increase in drug utilization and higher medication costs, according to the Medco 2010 Drug Trend Report. The growth in prescription drug use among children was nearly four times higher than the rise seen in the overall population.
A corresponding analysis of pediatric medication use found that in 2009, more than one in four insured children in the U.S. and nearly 30 percent of adolescents (10-19 year olds) took at least one prescription medication to treat a chronic condition; the most substantial increases were seen in the use of antipsychotic, diabetes and asthma drugs over the past nine years.
"While H1N1 caused a spike in antiviral use among children last year, the far more alarming trend since the beginning of the decade is the increasing use of medications taken by children on a regular basis and in some cases, for conditions that we don't often associate with youth, such as type 2 diabetes," said Dr. Robert S. Epstein, Medco's chief medical officer and president of the Medco Research Institute. "The fact that one-in-three adolescents are being treated for a chronic condition points to the need for additional health education and lifestyle changes that can address the obesity issue that is likely a driving force behind such conditions as type 2 diabetes and even asthma."
Type 2 Diabetes Continues Climbing in Kids
Type 2 diabetes medication use by juveniles increased 5.3 percent in 2009, the largest increase across all age groups, and higher than overall utilization growth of 2.3 percent. Since 2001, the number of children ages 19 and younger using these medications has risen more than 150 percent, with girls between 10 and 19 showing the greatest jump at nearly 200 percent. While growth in use of these treatments is substantial, the actual number of children using these drugs is still far less than is seen in adults.
The obesity epidemic may also be responsible for a higher prevalence of hypertension and gastroesophageal reflux disease (GERD) in youngsters. From 2001 to 2009, there was a 17 percent increase in the use of antihypertensives in children, with the greatest growth (29 percent) seen in boys ages 10-19. The number of children on proton pump inhibitors, used to treat heartburn and GERD, and in some cases prescribed for colic in infants, increased by 147 percent from 2001 to 2009.
Last week, The Archives of Internal Medicine published a study showing that daily use of these drugs increases the risk of infection by Clostridium difficile, a harmful intestinal bacteria.
Utilization and costs of behavioral drug treatments continue to rise in children. In 2009, 13.2 percent of the prescription drug benefit dollars spent on children went to ADHD treatments. However, the greatest spike in utilization growth last year was not seen in the youngest demographic but rather in adults aged 20-34 where use of these drugs rose 21.2 percent.
Among the drugs that have experienced substantial gains in the pediatric population are atypical antipsychotics; traditionally used to treat schizophrenia, these drugs have more recently been prescribed for a variety of psychiatric disorders. The nine-year analysis revealed that the use of these treatments in children has doubled over that time period. While atypicals are still more prevalent among boys, the rate of growth (130 percent) was greatest in girls ages 10-19.
"Atypical antipsychotics are extremely powerful drugs that are being used far too commonly – especially in children – given their safety issues and side effects," said Dr. David Muzina, a specialist in mood disorders and national practice leader of the Medco Therapeutic Resource Center for Neuroscience. "We're seeing them prescribed for a number of different conditions including depression and anxiety for which there is not good evidence that they are an effective treatment and yet we're exposing children to the possibility of extreme weight gain that could lead to a host of health problems including diabetes."
Questions of safety did have a major impact on curbing antidepressant use in young people, dropping about 23 percent since 2004 when the FDA issued its strongest safety warnings on the risk of suicidality in children using these medications.
Respiratory drug use grew 5.0 percent for children in 2009 and was up 42 percent since 2001. Rising asthma rates accounted for much of the increase, as well as greater awareness of the disease and the importance of early intervention in controlling disease progression. This class of drugs was responsible for the highest proportion of net costs of medications among children.
The H1N1 Factor
Children saw a 46 percent spike in the use of antiviral drugs, by far the largest increase of all age groups and driven by the high incidence of H1N1 in the young. Children's usage was primarily responsible for the 9.0 percent rise in utilization for the overall population.
Additional Pediatric Drug Developments
In 2009, the FDA expanded to pediatric patients the indications for cholesterol drugs, Welchol® (colesevalm HCl) and Crestor® (rosuvastatin); Atacand® (candesartan cilexetil) for hypertension; Axert® for migraines; heartburn treatment Protonix® (pantoprazole); and atypical antipsychotic medications Abilify® (aripriprazole), Seroquel® (quetieapine fumarate) and Zyprexa® (olanzapine).
Copies of the Medco 2010 Drug Trend Report can be downloaded from www.drugtrend.com.
Medco Health Solutions, Inc.