Nancy A. Melville

November 13, 2012

SAN FRANCISCO — The use of and spending on medications to slow aging-related processes has increased steadily in recent years. In some cases, the amount spent on anti-aging agents now equals the amount spent on treatments for chronic conditions, according to a new study.

However, costs have increased substantially more for patients covered by private insurance than for those covered by Medicare.

These findings were presented here at the American Public Health Association (APHA) 140th Annual Meeting.

Researchers evaluated pharmacy claims benefits data for medications with indications for 7 aging-related processes that were "once a normal part of the aging process and are now treated as a medical condition to be slowed and even reversed with medications."

The 7 processes studied were urinary symptoms (noninfection), mental alertness/memory issues, hormone replacement therapy (HRT), insomnia, sexual dysfunction, skin aging, and hair loss.

From 2007 to 2011, the average annual cost per patient for these agents increased by 46.0% in the privately insured population, and by just 1.3% in the Medicare population. In addition, annual use per patient increased 18.5% in the privately insured population and 32.0% in the Medicare population.

In patients covered by Medicare, use has "increased nearly 25-times that of the cost," said lead author Reethi Iyengar, PhD, a researcher at Express Scripts in St. Louis, Missouri. She noted that this could be related to the fact the Medicare population is generally older than population covered by private insurance.

In 2009, the only year to show a decrease in the use of anti-aging agents by Medicare patients, total annual costs per patient reached their highest point — $105.26.

"It is interesting that the only year in which the utilization trend was negative was when cost was highest," Dr. Iyengar said. "This could be indicative of people's demand sensitivity to the price of these medications," she noted.

In 2011, the top 3 conditions covered by Medicare were urinary symptoms, insomnia, and HRT; together, they accounted for 84.6% of total spending on aging-related conditions. The top 3 conditions covered by private insurance were mental alertness/memory issues, urinary symptoms, and HRT, which accounted for 76.8% of total spending.

The average annual cost per patient in 2011 for aging-related conditions covered by Medicare and private insurance was $73.33. This is higher than the average cost of high blood pressure or heart disease medications ($62.84), and only slightly less than the cost of medications for high cholesterol ($78.38) and diabetes ($81.12).

"The findings highlight shifting priorities in healthcare spending," Dr. Iyengar said.

"The increasing trend in the use and cost of these aging-related medications year over year presents a significant cost burden that parallels and, in some cases, even exceeds the cost burden presented by expensive chronic conditions," she said.

Dr. Iyengar noted that the study wasn't designed to determine the cause of the spending, and that consumer demand could play as significant a role as physician recommendations. This was beyond the scope of our study, she explained.

The medicalization of normal aging conditions is spurred, in part, by media and advertising that increases awareness of pharmaceutical treatments among consumers (J Health Soc Behav. 2005;46:3-14).

"We are not making a value judgment on whether this is good or not; we are just reporting on what the trends are. That's why we need pharmacy utilization management programs," she added.

"We don't want to limit access to these drugs," she said, but we want to make sure attention is paid to patient safety while still managing the cost trends.

According to Karen E. Peters, PhD, from the University of Illinois at Chicago School of Public Health, who moderated the session, it is fair to ask what is causing this trend.

"I believe the methodology [in this study] to be sound; however, these are cross-sectional trend data being reported on, and drug-taking is a 'longitudinal' process," said Dr. Peters.

Although "this snapshot indicates increased trends in both cost and utilization, we should ask what accounts for this: What are the changes going on in both Medicare plans and commercially insured plans from a policy perspective? Is there increased demand from patients for these types of drugs, or has there been new 'emphasis' to market these types of drugs?"

The increased use by the older Medicare population makes sense, but how long do older patients continue taking these "aging" medications? Likely for the rest of their life," Dr. Peters said.

"I am not disputing at all the conclusions drawn. In fact, I think the study points us to new research areas for why the trends are being seen," Dr. Peters said. "The authors rightly assert that more investigation is warranted."

Dr. Iyengar and Dr. Peters have disclosed no relevant financial relationships.

American Public Health Association (APHA) 140th Annual Meeting: Abstract 265-701. Presented October 30, 2012.

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