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