Trends in Critical Illness - Multiple Sclerosis

1
Trends in Critical Illness - Multiple
Sclerosis TPD
The Actuarial Profession making financial sense
of the future

• 1 October 2002
• Sue Elliott
• Hamish Galloway
• Daniel Ryan

2
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

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Prevalence
Watsone Wyatt EmployeeDR to complete ?

• 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

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Variety by Disability/Time Graphs
Watson Wyatt Employee DR to complete ?
RRMS
PPMS
PRMS
SPMS
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Age sex profile

• Age at onset 10 - 59 years, with peak between mid
  20's and early 30's
• Ratio of women to men
• 21 across all MS sufferers
• 11 for Primary Progressive

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Age sex profile
Watson Wyatt Employee DR to insert age chart
From Mumford and Compston (1995) Prevalence from
south Cambridgeshire district
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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

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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

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Symptoms

• Symptoms in order of perceived importance to MS
  sufferer
• Cognitive impairment
• Depression
• Spasticity weakness
• Ataxia tremor
• Bladder bowel dysfunction
• Fatigue
• Sexual dysfunction
• Pain

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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

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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?

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UK data sources (population)
Watson Wyatt Employee 1991 date subject to
change (DR)

• HES data - 1993 to 2001

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HES data trends
Watson Wyatt Employee DR to insert graph
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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)

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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

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UK regional statistics
Watson Wyatt Employee DR to insert UK regional
slide
From Robertson Compston (1995) - Surveying
multiple sclerosis in United Kingdom
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UK data sources (insured)

• "A Critical Review" - covers 1991-97
• 1998, 1999 - imminent (due at Health Conference
  2002)

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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)

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UK insured experience - MS
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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

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Global statistics
Watson Wyatt Employee DR to insert global stats
From McAlpine's Multiple Sclerosis 3rd Edition
(1998)
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Improved underwriting practices
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.

• Ease of anti-selection
• More probing questions required
• Family history
• Laboratory tests

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Total Permanent Disability (TPD)

• CIBT93
• UK insured experience
• Alternative approaches
• Alternative definitions
• Current issues

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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)

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UK insured experience - TPD
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Alternative approaches

• Long-term income protection claims by cause, ie
  D26
• Severe Disability Allowance (government
  statistics)

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Alternative definitions

• Own occupation
• Any occupation
• Activities of daily working (ADWs)
• Functional assessment tests (FATs)

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Current issues

• High level of declinatures (gt 50)
• potential mis-selling?
• Subjective definition (ie occupationally based)

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Trends in Critical Illness - Multiple
Sclerosis TPD
The Actuarial Profession making financial sense
of the future

• 1 October 2002
• Sue Elliott
• Hamish Galloway
• Daniel Ryan