Trends in Critical Illness - Multiple Sclerosis & TPD 1 October 2002 Sue Elliott Hamish Galloway...
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Transcript of Trends in Critical Illness - Multiple Sclerosis & TPD 1 October 2002 Sue Elliott Hamish Galloway...
Trends in Critical Illness - Multiple Sclerosis & TPD
1 October 2002
Sue Elliott
Hamish GallowayDaniel Ryan
The Actuarial Profession
making financial sense of the future
Multiple Sclerosis (MS)
Prevalence Age & sex profile Epidemiology Clinical vs insurance definition Symptoms Drugs and treatment Areas of future research Data sources:
UK - population UK - insured ("A Critical Review") Overseas - population
Improved underwriting practices
Prevalence
Estimated 85,000 sufferers in UK Varieties of MS
Relapsing remitting - 35-45% of total, 85% of initial presentation
Benign - 10-20% of total Primary progressive - 10% of total Progressive relapsing - 5% of total Secondary progressive - 30% of total
Watsone Wyatt Employee:DR to complete ?
Watsone Wyatt Employee:DR to complete ?
Variety by Disability/Time Graphs
RRMS
PRMS SPMS
PPMS
Watson Wyatt Employee:
DR to complete ?
Watson Wyatt Employee:
DR to complete ?
Age & sex profile
Age at onset 10 - 59 years, with peak between mid 20's and early 30's
Ratio of women to men: 2:1 across all MS sufferers 1:1 for Primary Progressive
Age & sex profile
From Mumford and Compston (1995)Prevalence from south Cambridgeshire district
Watson Wyatt Employee:
DR to insert age chart
Watson Wyatt Employee:
DR to insert age chart
Epidemiology
Geographic location: Distance from equator Ethnicity: Caucasian vs African/Asian Environmental factors
Seasonality Infective agent
Susceptibility genes Familial aggregation, twin studies Complex multifactorial incl. DR2 gene
Clinical vs insurance definition
Clinical Definition Poser criteria (1983) - 2 symptomatic attacks at 2 separate
sites in central nervous system including optic nerves Laboratory anomalies at 2nd site can replace requirement for
symptoms
Insurance Definition is diagnosis by a neurologist meeting all of the following criteria: Current impairment of motor or sensory function, which must
have persisted for a continuous period of at least six months Diagnosis must be confirmed by diagnostic techniques current
at the time of the claim Actual application in the industry
Symptoms
Symptoms in order of perceived importance to MS sufferer Cognitive impairment Depression Spasticity & weakness Ataxia & tremor Bladder & bowel dysfunction Fatigue Sexual dysfunction Pain
Drugs & treatment
Acute relapses Corticosteroids affect duration, severity and probability of
recovery from relapses
Disease modifying treatment Primarily affect number and severity of attacks Inconclusive as to impact on transition to progressive Interferon beta, Glatiramer acetate
Areas of future research
Primary prophylaxis of at risk individuals Relapse prevention & limiting Neuroprotective & restorative
Remyelination Protein growth factors
Better prospects than ever - hence question for insurance industry is will MS remain both permanent and critical?
UK data sources (population)
HES data - 1993 to 2001
Watson Wyatt Employee:
1991 date subject to change (DR)
Watson Wyatt Employee:
1991 date subject to change (DR)
HES data trends
Watson Wyatt Employee:
DR to insert graph
Watson Wyatt Employee:
DR to insert graph
MS Inpatient Admissions
0
2
4
6
8
10
12
14
16
1993/4 1998/9 1999/0 2000/1
Collection Period
No.
in 0
00s
Number of Admission Episodes Male Admission Episodes
UK data sources (population)
HES data - 1993 to 2001 MSGP - 1981/82, 1991/92, 2001/02(not available yet;
discussions are continuing within DoH about the possibility of another study)
UK data sources (population)
HES data - 1993 to 2001 MSGP - 1981/82, 1991/92, 2001/02(not available yet) MS Society (letter sent 24 July 2002 under Mike
Urmston's signature; initial feedback is positive) McAlpine - summary of different studies
UK regional statistics
From Robertson & Compston (1995) - Surveying multiple sclerosis in United Kingdom
Watson Wyatt Employee:
DR to insert UK regional slide
Watson Wyatt Employee:
DR to insert UK regional slide
UK data sources (insured)
"A Critical Review" - covers 1991-97 1998, 1999 - imminent (due at Health Conference
2002)
CIBT93 construction - MS
HES data 1994/95 MSGP data 1991/92 OPCS - Mortality Statistics by Cause, England &
Wales 1993 "Multiple Sclerosis" by Bernie O'Brien, Office of
Health Economics (1987)
UK insured experience - MS
MultipleSclerosis
All causes # claims % of total
Male non-smoker
54% 46% 41 2%
Malesmoker
93% 66% 17 3%
Femalenon-smoker
48% 43% 54 6%
Femalesmoker
50% 55% 13 5%
Overseas data sources (population)
Australia longitudinal study commenced in May 2002; first release of
results scheduled for May 2004
US SLIFKA - cohort study produced by National MS Society
International Federation of MS
Global statistics
From McAlpine's Multiple Sclerosis 3rd Edition (1998)
Watson Wyatt Employee:
DR to insert global stats
Watson Wyatt Employee:
DR to insert global stats
Improved underwriting practices
Ease of anti-selection More probing questions required Family history Laboratory tests
Watson Wyatt Employee:
HG to find out what the current questions are and what could be done if cost and public perception were not an issue.
Watson Wyatt Employee:
HG to find out what the current questions are and what could be done if cost and public perception were not an issue.
Total & Permanent Disability (TPD)
CIBT93 UK insured experience Alternative approaches Alternative definitions Current issues
CIBT93 construction - TPD
No published data available in the UK Condition invented by the insurance industry Safety net for CI policies IIP data (CMIR7 & CMIR15) Cause of claim data (CMIR8)
UK insured experience - TPD
TPD All causes # claims % of total
Male non-smoker
41% 46% 81 4%
Malesmoker
48% 66% 21 4%
Femalenon-smoker
31% 43% 42 5%
Femalesmoker
39% 55% 12 5%
Alternative approaches
Long-term income protection claims by cause, ie D26+
Severe Disability Allowance (government statistics)
Alternative definitions
Own occupation Any occupation Activities of daily working (ADWs) Functional assessment tests (FATs)
Current issues
High level of declinatures (> 50%) potential mis-selling?
Subjective definition (ie occupationally based)
Trends in Critical Illness - Multiple Sclerosis & TPD
1 October 2002
Sue Elliott
Hamish GallowayDaniel Ryan
The Actuarial Profession
making financial sense of the future