A top-down market size. It asks what a gerotherapeutic category could be worth if one opened, by counting people and multiplying by a price. It does not use our asset data, it is not a forecast, and it is never added to the aging-disease pipeline figure — the two are separate numbers describing different things, and summing them would double-count.
Every control is an assumption you set. No aging approval pathway exists today.
TAM = Σregion min( population × uptake × price × realisation , cap ),
ramped from the trigger year by an S-curve over the diffusion period.
Each region is computed separately at its own price level and its own ceiling, then summed. Earlier versions pooled the population and applied one US price, which overstated every non-US market.
| Parameter | Value | Basis | Confidence |
|---|---|---|---|
| Population | see table | UN DESA World Population Prospects 2024, medium variant, 2030, single year of age. Europe = EU27+UK+EFTA (32 countries). | SOURCED |
| Price — statin | $500 | Mass cheap preventative; branded-statin era ~$1k/yr, generic ~$50. | ANALOGUE |
| Price — GLP-1 | $6,000 | Net ~$5–6k/yr in 2024 against ~$12k list. The most any broad class has achieved. | ANALOGUE |
| Price — Regen-platform | $100,000 | A one-time regenerative therapy priced for a mass market — roughly a GLP-1 lifetime ($5–6k/yr × ~15–20yr). It is affordability-bounded, not modality-derived: autologous CAR-T sits at $400–500k and real one-time gene therapies run $2–4M (Zolgensma, Hemgenix, Lenmeldy) — but those are rare-disease prices a broad-aging market cannot bear. Price and scale trade off: reach mass scale (in-vivo / allogeneic) and the price must fall to about here; hold a rare-disease price and the volume is tiny. So the in-vivo route does not push this up — if anything the cheap COVID-vaccine-style delivery argues it lower. Our own grounded per-indication prices run $0.02–4.0M across the niche-to-mass span; $100k is the mass end. Selecting it sets uptake 1% and age over-60 (a procedure, not a daily preventative); both remain adjustable. | ANALOGUE |
| Peak uptake | 35% | Steady-state penetration of the age-eligible population. Benchmarks (whole-population, US): statins ~28% of over-40s (CDC/NHANES Data Brief 177); GLP-1 ~22% in the 50–64 band today (KFF); flu ~67% in over-65s (CDC); COVID ~80% first dose (emergency — the 100% dial). 35% is an optimistic-central — above statins and GLP-1, below the vaccine ceilings — and its defensibility rises with the age cutoff. | ASSUMPTION |
| Realisation — all regions | US 1.00 EU 0.255 JP 0.209 CN 0.033 RoW 0.018 |
Definition: a region's per-capita pharmaceutical market value as a ratio to the US — for
every dollar realised per person in the US, this region realises X. Embeds price and access
together; a price ratio alone corrects what a drug sells for, not how many people receive it.
Source: EFPIA Key Data 2025 p14, citing IQVIA MIDAS audited sales FY2024. World prescription market $1,528,535M at ex-factory prices: North America 54.8%, Europe 22.7%, China 7.1%, Japan 4.0%, Latin America 4.1%, Africa/Asia/Australia 7.4%. Ex-factory is manufacturer revenue — the same basis as our numerator. Two derivations, not sourced: US is North America less ~2.1pp for Canada; EFPIA's Europe includes Russia, Turkey, Ukraine and Belarus, so ~90% of European value is attributed to our EU27+UK+EFTA definition. A second basis is retained. An earlier set (Europe 0.53, Japan 0.58, China 0.02) came from OECD per-capita pharmaceutical expenditure, which is retail-scoped and so excludes hospital-administered drugs — flattering every non-US market. It is kept selectable because the basis choice materially moves the headline. On the current default (Global / over-45 / GLP-1 / 35%), the retail basis gives $854bn against $617bn on this ex-factory one — a ~$237bn swing from the basis alone. The difference is a basis choice, not a data update, and should be settled deliberately. Drugs only. This is the pharmaceutical market — it excludes hospital, physician and social-care spend (drugs are only ~10–15% of total health spend). That is deliberate: the factor proxies a drug's regional reach, and drug-market value is the right proxy for reach. Whether a gerotherapeutic could also draw on the far larger care budget it offsets is the market-ceiling question — see Should the ceiling be off? below. |
SOURCED |
| Market ceilings | US $644bn EU $203bn JP $43bn CN $16bn RoW $72bn |
Same EFPIA/IQVIA ex-factory figures, times an assumed branded share of each market
(80/65/70/15/30%). The branded share is the judgement here, not a sourced number.
Deliberately not IQVIA's headline list-price spending: our numerator is net, and capping a net numerator with a list denominator would inflate the ceiling by the entire list-to-net gap — roughly threefold in the US. These are the FY2024 base; in the model each ceiling is grown to the peak year (trigger + ramp) at IQVIA-derived real, net regional rates — see How the ceiling works below. |
SOURCED |
| Cap share | off by default | Maximum share of a region's innovative-drug market one therapeutic class may take. Off by default; adjustable 5–100%. When engaged, 25% is already generous against the largest real class: GLP-1 took $131.9bn of $915.2bn of US prescription-drug spending in 2025, ~14%, and nearly a third of all growth that year (ASHP/AJHP 2026). | JUDGEMENT |
| Diffusion | 10 yr | Years from first approval to steady state, as a smoothstep S-curve. | ASSUMPTION |
| Trigger year | 2035 | A dial you set, not a model output. We have set the point for a gerotherapeutic regulatory pathway at 2035. 2035 isn't a hopeful guess, it's where the slowest of the three timing factors actually lands. That's also why we keep calling it conservative: CMS and ARPA-H are already signalling institutional appetite well ahead of the regulatory machinery catching up, so the constraint isn't willingness; it's process: see the full report for the rationale. | DIAL |
Population maths alone overstates wildly: pricing everyone over 45 at the US net price gives $6.0tn/yr — six times all the branded medicine sold on earth. The realisation factor pulls that back to $617bn by embedding each region's real price and access. But even then some regions overshoot what their market could absorb — China computes to $47bn against a whole branded market of just $16bn. The ceiling catches that residual.
Successive corrections on the default settings (Global / over-45 / GLP-1 / 35%): $6,012bn pooled at US prices → $617bn with realisation → $310bn with realisation and a 20% ceiling.
The case for turning it off (the expansion view). The cap benchmarks a class against today's drug market. A gerotherapeutic that delays several age-related diseases at once is arguably a new category, not another entrant in the existing one — and two arguments give it budget the cap cannot see. First, the realisation factor and the ceiling are drug-market only; the therapy's value is that it offsets hospital and care costs, a pool five-to-ten times larger than the drug budget it sits in. Second, the welfare value is vast: Scott, Ellison & Sinclair (Nature Aging, 2021) put a one-year rise in US life expectancy from slowing aging at ~$38tn (ten years at $367tn) — a number that, even fractionally captured, dwarfs any single drug class. The ceiling already grows its denominator to the peak-year market (see How the ceiling works); the residual case for switching it off is that a genuine new category could expand the market beyond that trend — which no share-of-market ceiling can capture.
The case for keeping it on (the anchor). The largest real single class is GLP-1, at $131.9bn of the $915.2bn spent on US prescription drugs in 2025 — ~14%, and nearly a third of all growth that year (ASHP/AJHP 2026). The largest therapy area, oncology across dozens of mechanisms, is forecast above $300bn and remains the most valuable area into 2030 (Evaluate). So a single class at 25%+ of a national branded market would be without precedent — though note GLP-1 reached 14% in about five years, so “unprecedented” is not the same as implausible. And the welfare figure is willingness-to-pay, not cash: health systems do not fund by what something is worth, they fund by a cost-per-QALY threshold (NICE ~£25–35k, raised from £20–30k in April 2026; US/ICER ~$100–150k) and an affordability test on top. Sofosbuvir (Sovaldi) is the precedent: cost-effective per patient (~$47k/QALY) and still rationed — 74% of state Medicaid programmes restricted it to advanced-fibrosis patients because treating everyone (over $1bn in 2014 alone, for under 2.4% of infected enrollees) was unaffordable (US Senate Finance Committee; Annals of Internal Medicine, 2015). A mass gerotherapeutic hits the same wall: value clears the threshold, budget impact forces rationing, realised uptake and spend land below the ceiling. The shift to prevention reinforces this — systems are moving to prevention because they are cost-pressured, to bend the curve down, not to open a new spending line.
Where that leaves the dial. Cap-off is a legitimate, clearly-labelled category-expansion scenario — “this draws on the wider health budget and society chooses to fund longevity” — and the on-screen advisory guards it. Cap-on (25%) is the conservative anchor, consistent with every drug class to date. The value-of-longevity argument is real, but its natural home is the price dial — what a threshold-clearing system will pay per patient — not the assumption that one class dwarfs the entire drug market.
The ceiling holds each region's figure to at most a chosen share of that region's branded drug market. It is off by default and adjustable. With it off, the figure is not held to any market share: at the default settings the implied class would be 51% of the US branded drug market, 72% of Europe's, 73% of Japan's, 89% of Rest of World's and 292% of China's. For context, the largest single therapeutic class on record is GLP-1 at ~14% of US prescription-drug spending ($131.9bn of $915.2bn, 2025 — ASHP/AJHP 2026), and the largest therapy area — oncology, across dozens of mechanisms — is forecast above $300bn, the most valuable area into 2030 (Evaluate). The ceiling lets the reader hold the figure to a plausible share; where to set it is a judgement, which is why it is a slider rather than a fixed number.
The denominator is date-matched to the peak. When the ceiling is on, it means “at most X% of the drug market at the therapy's peak” — and the peak is ~2044, not today. So each FY2024 ceiling is grown to the peak year (trigger + ramp) at region-specific real, net rates derived from IQVIA Global Use of Medicines 2024: US +2.0%, Europe +2.0%, Japan −0.5% (biennial price cuts), China +2.5% (volume-based procurement holds spending down despite fast volume), Rest of World +5.0%. These convert IQVIA's nominal, list-price regional CAGRs (Developed 5–8%, Pharmerging 10–13%, US net 2–5%, Japan −1 to +2%) to the real, net basis this model uses. Holding a five-year CAGR constant to the peak year is a modelled extrapolation, not a sourced figure — growth decays as markets mature, so the ~10-year figure is the firmer one and the ~20-year figure the upper edge.
| Ceiling | Denominator | Headline | What it represents |
| Off | — | $617bn | Not held to any market share — implies 292% of China's branded market |
| 20% | 2024 market | $196bn | 20% of today's drug market |
| 20% | grown to peak | $310bn | 20% of the projected 2040s market |
| 25% | grown to peak | $387bn | 25% of the 2040s market — a category (not single-class) benchmark |
Headlines at Global / over-45 / GLP-1 / 35% uptake; grown figures use the default trigger (2035) and ramp (10yr), i.e. a 2045 peak, and move with those sliders.
Ranked by how far the result shifts if the parameter is wrong. This is the order we would firm these up in, and the reason each is adjustable rather than fixed.
