While the swine flu outbreak of 2009 helped drive use of prescription drugs among children last year, a new study finds that chronic conditions such as type 2 diabetes and asthma have helped turn children into the fastest growing segment of the prescription drug market in the United States. The growth in prescription drug use among children was nearly four times higher than the rise seen in the overall population, according to pharmacy benefits manager Medco.

In 2009, drug trend for children–a measure of prescription spending growth–increased 10.8 percent, driven by a 5 percent increase in drug use and higher medication costs, according to the Medco 2010 Drug Trend Report. A corresponding analysis of pediatric medication use found that in 2009, more than one in four insured children in the United States 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, Medco said.

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 flu in the young. Children's usage was primarily responsible for the 9.0 percent rise in utilization for the overall population.

“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,” says 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 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.

Respiratory drug use grew 5 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 obesity epidemic may also be responsible for a higher prevalence of hypertension and gastroesophageal reflux disease or GERD among youth. From 2001 to 2009, there was a 17 percent increase in the use of antihypertensives in children. 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.

Behavioral drug treatments among children is also on the rise. 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.
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 suicide in children using these medications. But 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.

“Atypical antipsychotics are extremely powerful drugs that are being used far too commonly – especially in children – given their safety issues and side effects,” says 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.”

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).