May 9 2005
It is well known that hypertension, diabetes, and obesity are each taking a toll on Americans' health, but according to a new analysis, metabolic syndrome, a condition characterized by a combination of these and/or other risk factors, is fast becoming one of the nation's costliest health concerns.
According to new research by Medco Health Solutions, the average yearly pharmacy cost of treating adult patients over age 20 with metabolic syndrome exceeds $4,000, which is more than four times the average annual drug cost for all other patients. It was found that the number of adults being treated for the conditions associated with metabolic syndrome increased more than 36 percent from 2002 to 2004.
Dr. David M. Nathan, professor of medicine at Harvard Medical School and director of the Diabetes Center at Massachusetts General Hospital, says that metabolic syndrome, and its components, diabetes and pre-diabetes, obesity, hypertension, and abnormal lipids, appears to be the major public health problem to be faced in the 21st century.
The long-term consequences, including heart disease, stroke, and the other complications of diabetes, can be reduced with aggressive treatment of risk factors, but at a substantial cost. Lifestyle approaches should also decrease metabolic syndrome and its long-term health and economic costs.
Patients with metabolic syndrome have three or more risk factors, which include excessive abdominal fat, hypertension, low amounts of "good" cholesterol (HDL), elevated triglyceride levels, and abnormal blood sugar, and are at a 3.5 times greater risk of death from coronary heart disease, as well as an increased risk of liver and kidney disease, and possibly cancer. It is closely associated with a generalized metabolic disorder in which the body is unable to use insulin efficiently and although some people are genetically disposed, others can develop the syndrome due to excess body fat and physical inactivity.
Non-drug treatments for metabolic syndrome include weight loss, dietary changes and increased physical activity. One recently published study from the University of Pittsburgh found that a program involving weight loss and exercise decreased the incidence of metabolic syndrome by almost 41 percent as compared to the control group, while the incidence rate among patients on drug therapy was reduced by only 17 percent.
Dr. Roger Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, emphasizes that the best treatments for metabolic syndrome and the prevention of diabetes incorporate better dietary and exercise habits.
Medco's analysis reviewed prescription drug data for approximately 2 million adult patients aged 20 years or older. Those categorized with metabolic syndrome were taking medications for at least three of the risk factors associated with the syndrome, diabetes, abnormal cholesterol and hypertension. Due to the low prevalence of people on weight loss prescription medications, obesity was not calculated into the cost of metabolic syndrome, but it is a major contributor to the prevalence of this condition.
Among the major findings of the analysis were that the greatest growth in the prevalence of metabolic syndrome (2002-2004) was among people between 20 and 44 years old, a 49 percent increase, and there was a 20 percent jump (2002-2004) in the number of patients with two risk factors for metabolic syndrome, a population that may be on the verge of developing the condition. Taken together, patients with metabolic syndrome and those at risk accounted for $4 out of every $10 spent on prescription medications for adults.
To respond to the rise of metabolic syndrome, and the costs associated with the condition, Medco will launch the nation's first physician alert system that will use integrated claims data to identify those patients that have, or are at risk of developing, metabolic syndrome. Using Medco's RationalMed® Patient Safety Solutions, enhanced clinical rules will cross-reference pharmacy claims data with laboratory and medical claims data to identify these patients.
Once identified, an alert package will be sent to the prescribing physician and the patient providing them with information and recommendations for changes in therapy and/or lifestyle. Currently, approximately 50 percent of the physicians who receive an alert package generated by RationalMed® make an immediate change in the patient's therapy.
Dr. Robert Epstein, Medco's chief medical officer, says that according to Medco data, metabolic syndrome patients are, on average, prescribed medications by five different physicians and 25 percent are seeing seven different prescribing doctors. He added that these physicians might not always be aware of the myriad of conditions affecting the patient.
He says their data allows them to track patients using medications for two or more of the metabolic syndrome risk factors, identifying them as either at risk for, or afflicted with metabolic syndrome, and that information can assist physicians in making the most appropriate treatment choices for their patients.
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