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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 Daniel Ryan. Multiple Sclerosis (MS). Prevalence Age & sex profile Epidemiology Clinical vs insurance definition Symptoms

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Trends in critical illness multiple sclerosis tpd

The Actuarial Profession

making financial sense of the future

Trends in Critical Illness - Multiple Sclerosis & TPD

1 October 2002

Sue Elliott

Hamish Galloway

Daniel Ryan


Multiple sclerosis ms
MultipleSclerosis(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

Watsone Wyatt Employee:DR to complete ?

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


Variety by disability time graphs

Watson Wyatt Employee:

DR to complete ?

Variety by Disability/Time Graphs

RRMS

PPMS

PRMS

SPMS


Age sex profile
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 profile1

Watson Wyatt Employee:

DR to insert age chart

Age & sex profile

From Mumford and Compston (1995)

Prevalence from south Cambridgeshire district


Epidemiology
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 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

  • 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
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
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

Watson Wyatt Employee:

1991 date subject to change (DR)

UK data sources (population)

  • HES data - 1993 to 2001


Hes data trends

Watson Wyatt Employee:

DR to insert graph

HES data trends


Uk data sources population1
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 population2
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

Watson Wyatt Employee:

DR to insert UK regional slide

UK regional statistics

From Robertson & Compston (1995) -

Surveying multiple sclerosis in United Kingdom


Uk data sources insured
UK data sources (insured)

  • "A Critical Review" - covers 1991-97

  • 1998, 1999 - imminent (due at Health Conference 2002)


Cibt93 construction ms
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)



Overseas data sources population
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

Watson Wyatt Employee:

DR to insert global stats

Global statistics

From McAlpine's Multiple Sclerosis 3rd Edition (1998)


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.

Improved underwriting practices

  • Ease of anti-selection

  • More probing questions required

  • Family history

  • Laboratory tests


Total permanent disability tpd
Total & Permanent Disability (TPD)

  • CIBT93

  • UK insured experience

  • Alternative approaches

  • Alternative definitions

  • Current issues


Cibt93 construction tpd
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)



Alternative approaches
Alternative approaches

  • Long-term income protection claims by cause, ie D26+

  • Severe Disability Allowance (government statistics)


Alternative definitions
Alternative definitions

  • Own occupation

  • Any occupation

  • Activities of daily working (ADWs)

  • Functional assessment tests (FATs)


Current issues
Current issues

  • High level of declinatures (> 50%)

    • potential mis-selling?

  • Subjective definition (ie occupationally based)


Trends in critical illness multiple sclerosis tpd1

The Actuarial Profession

making financial sense of the future

Trends in Critical Illness - Multiple Sclerosis & TPD

1 October 2002

Sue Elliott

Hamish Galloway

Daniel Ryan


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