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Trends in Critical Illness - Multiple Sclerosis

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The Actuarial Profession making financial sense of the future Trends in Critical Illness - Multiple Sclerosis & TPD 1 October 2002 Sue Elliott Hamish Galloway – PowerPoint PPT presentation

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Title: 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

3
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

4
Variety by Disability/Time Graphs
Watson Wyatt Employee DR to complete ?
RRMS
PPMS
PRMS
SPMS
5
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

6
Age sex profile
Watson Wyatt Employee DR to insert age chart
From Mumford and Compston (1995) Prevalence from
south Cambridgeshire district
7
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

8
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

9
Symptoms
  • Symptoms in order of perceived importance to MS
    sufferer
  • Cognitive impairment
  • Depression
  • Spasticity weakness
  • Ataxia tremor
  • Bladder bowel dysfunction
  • Fatigue
  • Sexual dysfunction
  • Pain

10
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

11
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?

12
UK data sources (population)
Watson Wyatt Employee 1991 date subject to
change (DR)
  • HES data - 1993 to 2001

13
HES data trends
Watson Wyatt Employee DR to insert graph
14
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)

15
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

16
UK regional statistics
Watson Wyatt Employee DR to insert UK regional
slide
From Robertson Compston (1995) - Surveying
multiple sclerosis in United Kingdom
17
UK data sources (insured)
  • "A Critical Review" - covers 1991-97
  • 1998, 1999 - imminent (due at Health Conference
    2002)

18
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)

19
UK insured experience - MS
20
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

21
Global statistics
Watson Wyatt Employee DR to insert global stats
From McAlpine's Multiple Sclerosis 3rd Edition
(1998)
22
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

23
Total Permanent Disability (TPD)
  • CIBT93
  • UK insured experience
  • Alternative approaches
  • Alternative definitions
  • Current issues

24
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)

25
UK insured experience - TPD
26
Alternative approaches
  • Long-term income protection claims by cause, ie
    D26
  • Severe Disability Allowance (government
    statistics)

27
Alternative definitions
  • Own occupation
  • Any occupation
  • Activities of daily working (ADWs)
  • Functional assessment tests (FATs)

28
Current issues
  • High level of declinatures (gt 50)
  • potential mis-selling?
  • Subjective definition (ie occupationally based)

29
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
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