Longevity Comes of Age

What You Need to Know:

• Longevity is becoming a defined consumer market focused on extending health span, not just lifespan.
• Core opportunities include screening and monitoring, nutrition, mobility and fitness, and lifestyle solutions.
• We size the Tier 1 and 2 longevity market at over US$250 billion.
• Growth is supported by self-pay demand, HSA/FSA eligibility, reimbursement potential and greater consumer agency.
• Key areas to watch include peptides beyond GLP-1s and blood-based screening, including multi-cancer early detection.

The TD Cowen Insight

Longevity is emerging as the next chapter in the consumerization of health care. The core of this field is focused on screening, mobility and fitness, nutrition and lifestyle solutions. We size the current total addressable market (TAM) at over US$250 billion. There is participation from more than 50 private and public companies enabled by advances in artificial intelligence (AI), biological breakthroughs, policies and more. We see material growth potential as the field advances.

Our Thesis

For most of human history, the pursuit of longer life belonged to myth (e.g., the Holy Grail, the Fountain of Youth). The desire to transcend aging and sickness has been a largely unattainable ambition. 'Longevity' solutions aim to extend an individual's health span – the portion of life spent without significant chronic disease or disability. While this will to live longer and healthier is universal, the means to do so have remained elusive.

We believe today's enthusiasm towards longevity solutions is more than the repackaged wellness trends from decades earlier. It is the latest chapter in the consumerization of health care theme that we first outlined four years ago as a nascent convergence of health care, wellness, digital platforms as consumers were beginning to experiment with a new sense of agency over their health decisions post-COVID.

Health and wellness trends have ebbed and flowed, and enthusiasm often outpaced evidence – due in part to challenges within the traditional health care market. Health care has been a high barrier to entry market with complex science, long development timelines and opaque market dynamics. All parties – patients in particular – were limited by data and knowledge of their own biology as doctors and payors acted as gatekeepers, often post-symptomatically.

Today, we believe that dynamic is shifting. Fundamental changes within health care and consumer markets have enabled a convergence at the node of improving lifespan and health span. Tools to measure and screen health status – across blood-based testing, imaging and wearables – have advanced meaningfully. At the same time, new powerful consumer channels have emerged, and regulators are becoming aligned around products that not only extend lifespan but health span. In some areas of health care, historical gatekeepers are giving way to patient agency, improving accessibility. As health care and consumer lanes merge, they bring opportunities for the traditional health care investor and the consumer investor focused on preventative, proactive health and wellness.

What was once a fragmented and aspirational concept is becoming a defined, multi-sector ecosystem – spanning life science tools, diagnostics, therapeutics and consumer health. Many of the longevity tools and offerings are gaining traction today. In that context, longevity is no longer a distant ideal or a purely speculative theme. It is an emerging category with real revenue streams, measurable outcomes and growing strategic importance.

In this report, we seek to put early guardrails around what we view as the core market of longevity. These are the tools, services and products that are directly enabling people to live healthier, longer. While longevity isn't likely limited to these inputs, we believe that any investment thesis around longevity starts with these key pillars:

• baseline screening and monitoring,
• nutrition and diet,
• mobility and fitness
• and lifestyle (e.g., sleep, smoking, etc.).

These four categories underlie the most significant risks associated with the leading causes of death and disability – cardiometabolic disease, cancer and neurodegeneration. Innovative new products and services have emerged that address these pillars. We have also developed a framework to define the key markets served under the longevity umbrella – from the health optimizer in Tier 1 who is redefining longevity as a luxury, to the more budget-conscious Tier 2 consumer looking for à la carte wellness, to the 'already diagnosed' patient in Tier 3.

Overall, we size the Tier 1 and 2 longevity market at over $250 billion. We also highlight within more than 50 public and private companies that serve these four pillars across the different consumer segments. There is an overview of the $560 billion+ traditional health care market for cardiometabolic diseases, oncology and neurodegenerative diseases.

What You'll Find in Our Full Research Report

This multi-analyst, multi-sector report leverages our deep health care team expertise alongside our consumer team. It builds upon on our early research into the consumerization of health care and is supplemented by recent deep dives into blood-based screening, GLP-1 market estimates and TD Cowen's annual Therapeutics update. We delve into cross-sector trends and highlight over 50 companies throughout that are directly connected to the longevity theme. Insights are further buttressed by a proprietary survey of 2,500 consumers, analysis of health reimbursement trends (including health savings accounts) and Nielsen data. We also feature insights from our conferences and one-on-one calls with longevity key opinion leaders (KOLs) and companies in the space.

Financial and Industry Model Implications

We believe the most significant opportunity for accelerating growth in longevity today sits largely within the overlap of luxury consumer wellness and traditional health care. This can be found particularly in direct-to-consumer diagnostics and screening, preventative care, concierge medicine services, continuous glucose monitoring (CGM) and nutrition/supplements.

Traditional health care markets are often bound by regulatory frameworks that define critical value inflections as well as commercial and government payor decisions (e.g., FDA approvals and insurance coverage determinations). While some longevity products are subject to more strict FDA oversight and therefore carry some risk, much of the market we highlight within is self-pay. While this could make it more sensitive to consumer wallet pressures such as inflation, we believe that—unlike other luxury goods—its linkage to health could maintain longevity's priority amid other pressures.

Additionally, our research of health savings account balances and creation finds that these could be an underappreciated resource for some of the longevity spend. Over time, for blood-based screening, we expect that Medicare coverage unlocks significant growth potential.

Within the report, we highlight the opportunities that are eligible for health spending accounts (has) and flexible spending accounts (FSA). Ultimately, we believe that growth in this market will continue to accelerate, driven by AI, advances in our understanding of human biology and further reductions in barriers to access. Specifically, the Trump Administration's focus on drug prices has forced more companies to move more drug products to direct-to-consumer (DTC) platforms. Additionally, the FDA continues to transition certain medicines to over the counter (OTC). Both changes will give consumers more agency over their health.

Our TAM analysis considers only a fraction of Americans as participants in the longevity economy. However, if these actions continue to reduce barriers, people begin to see and appreciate health advantages with these products. As employer insurance models continue to put more financial decisions onto consumers, we believe this represents upside to our estimates.

What To Watch For

Peptides, beyond GLP-1s, are a fast-emerging new area in the longevity space. The FDA has decided to review a handful of peptides it had previously banned from the compounded products list.

We also continue to track clinical data, testing volumes, and reimbursement decisions across the multi-cancer early detection (MCED) space as well as other blood-based screening tests.