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The Impact of Genetic Information on the Insurance Industry: Conclusions from the ‘Bottom-Up’ Modelling Programme

Published online by Cambridge University Press:  09 August 2013

Angus Macdonald
Affiliation:
Department of Actuarial Mathematics and Statistics and the Maxwell Institute for Mathematical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, U.K.Tel: +44(0)131-451-3209, Fax: +44(0)131-451-3249, E-Mail: [email protected]

Abstract

We quantify the overall impact of genetic information on the insurance industry using the ‘bottom-up’ approach, in which detailed models are constructed of representative major genetic disorders. We consider six such disorders, namely adult polycystic kidney disease, early-onset Alzheimer's disease, Huntington's disease, myotonic dystrophy (MD), hereditary non-polyposis colorectal cancer; and breast/ovarian cancer. Actuarial models based on the epidemiological literature exist for all these except MD. We parameterise a suitable model of MD, then synthesize the results from all six models to estimate the adverse selection costs arising from restrictions on insurers' use of genetic information. These are all very small, only in the most extreme cases rising above 1% of premiums. In the worst case — females displaying ‘extreme’ adverse selection in a ‘small’ critical illness insurance market, with the use of family history banned — the cost is about 3% of premiums. Our model includes the most common single-gene disorders relevant to insurance, and includes representatives of most important classes of these disorders. While the ‘bottom-up’ approach could be continued by modelling more and more diseases, we suggest that our model is adequate to draw robust conclusions.

Type
Research Article
Copyright
Copyright © International Actuarial Association 2011

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References

Bell, J. (1947) Dystrophia myotonic and allied diseases, in Treasury of Human Inheritance 4, Part V, ed. Penrose, L.S.., Cambridge University Press, Cambridge.Google Scholar
Bouchard, G., Roy, R., Declos, M., Kouladjian, K. and Mathieu, J. (1988) Spreading of the gene for myotonic dystrophy in Saguenay (Quebec). Journal de Génétique Humaine 36, 221237.Google Scholar
Brackenridge, R. and Elder, J. (1998) Medical Selection of Life Risks 4th edition. Macmillan, New York.Google Scholar
Espinosa, C. and Macdonald, A.S. (2007) A correction for ascertainment bias in estimating rates of onset of highly penetrant genetic disorders. ASTIN Bulletin, 37, 429452.Google Scholar
Ford, C., Kidd, A. and Hammond-Tooke, G. (2006) Myotonic dystrophy in Otago, New Zealand. New Zealand Medical Journal, 119, U2145Google ScholarPubMed
Frohock, A.M. (2003) The CTG expansion mutation in myotonic dystrophy: Genotype-phenotype comparisons and the relevance to insurance. Final Year Honours Project. Unpublished dissertation, University of Nottingham.Google Scholar
Grimm, T. (1975) Myotonic dystrophy. Ph.D. Thesis. University of Göttingen.Google Scholar
Gui, E.H. (2003) Modelling the impact of genetic testing on insurance – Early-onset Alzheimer's disease and other single-gene disorders. Ph.D Thesis. Heriot-Watt University.Google Scholar
Gui, E.H. and Macdonald, A.S. (2002) A Nelson-Aalen estimate of the incidence rates of early-onset Alzheimer's disease associated with the Presenilin-1 gene. ASTIN Bulletin, 32, 142.Google Scholar
Gui, E.H., Lu, B., Macdonald, A.S., Waters, H.R. and Wekwete, C. (2006) The genetics of breast and ovarian cancer III: A new model of family history with insurance applications. Scandinavian Actuarial Journal, 2006, 338367.Google Scholar
Gutiérrez, C. and Macdonald, A.S. (2003) Adult polycystic kidney disease and critical illness insurance. North American Actuarial Journal, 7, 93115.CrossRefGoogle Scholar
Gutiérrez, C. and Macdonald, A.S. (2004) Huntington's disease, critical illness insurance and life insurance. Scandinavian Actuarial Journal, 2004, 279313.Google Scholar
Gutiérrez, C. and Macdonald, A.S. (2007) Adult polycystic kidney disease and insurance: A case study in genetic heterogeneity. North American Actuarial Journal, 11, 90118.CrossRefGoogle Scholar
Harper, P.S. (1973) Pre-symptomatic detection and genetic counselling in myotonic dystrophy. Clinical Genetics, 4, 134140.Google Scholar
Harper, P.S. (1996) Huntington's Disease. WB Saunders, London.Google Scholar
Harper, P.S. (2001) Myotonic Dystrophy. WB Saunders, London.Google Scholar
HGAC (1997) The implications of genetic testing for insurance. Human Genetics Advisory Commission, London.Google Scholar
HGC (2000) Whose hands on your genes? Human Genetics Commission, London.Google Scholar
Hodge, S.E. (2002) Ascertainment, in Biostatistical genetics and genetic epidemiology, eds. Elston, R., Olson, J. & Palmer, L. John Wiley.Google Scholar
Höweler, C.J. (1986) A clinical and genetic study in myotonic dystrophy. PhD Thesis. University of Rotterdam.Google Scholar
Hsiao, K.M., Chen, S.S., Li, S.Y., Chiang, S.Y., Lin, H.M., Pan, H., Huang, C.C., Kuo, H.C., Jou, S.B., Su, C.C., Ro, L.S., Liu, C.S., Lo, M.C., Chen, C.M. and Lin, C.C. (2003) Epidemiological and genetic studies of myotonic dystrophy type 1 in Taiwan. Neuroepidemiology, 22, 283289.Google Scholar
Klein, D. (1958) La dystrophie myotonique (Steinert) et la myotonie congénitale (Thomsen) en Suisse: étude clinique, génétique et démographique. Journal de Génétique Humaine, 7 SUPPL, 1328.Google Scholar
López de Munain, A., Emparanza, J.I., Poza, J.J., Martí Massó, J.F., Cobo, A., Martorell, L., Baiget, M. and Martínez Lage, J.M. (1993) Prevalence of myotonic dystrophy in Guipúzcoa (Basque Country, Spain). Neurology, 43, 15731576.CrossRefGoogle ScholarPubMed
Lu, L., Macdonald, A.S., Waters, H.R. and Yu, F. (2007) A dynamic family history model of hereditary nonpolyposis colorectal cancer and critical illness insurance. Annals of Actuarial Science, 2, 289325.CrossRefGoogle Scholar
MacCalman, L. (2009) Effects of genetic testing on insurance: Pedigree analysis and ascertainment adjustment. Ph.D Thesis. Heriot-Watt University.Google Scholar
Macdonald, A.S. (1997) How will improved forecasts of individual lifetimes affect underwriting? British Actuarial Journal, 3, 10441058.Google Scholar
Macdonald, A.S. (1999) Modelling the impact of genetics on insurance. North American Actuarial Journal, 3, 83101.Google Scholar
Macdonald, A.S. (2003a) Genetics and insurance: What we have learned so far? Scandinavian Actuarial Journal, 2003, 324328.CrossRefGoogle Scholar
Macdonald, A.S. (2003b) Moratoria on the use of genetic tests and family history for mortgagerelated life insurance. British Actuarial Journal, 9, 279311.Google Scholar
Macdonald, A.S., Waters, H.R. and Wekwete, C.T. (2003a) The genetics of breast and ovarian cancer I: A model of family history. Scandinavian Actuarial Journal, 2003, 127.Google Scholar
Macdonald, A.S., Waters, H.R. and Wekwete, C.T. (2003b) The genetics of breast and ovarian cancer II: A model of critical insurance. Scandinavian Actuarial Journal, 2003, 2850.CrossRefGoogle Scholar
Macdonald, A.S. and Tapadar, P. (2010) Multifactorial genetic disorders and adverse selection: Epidemiology meets economics. Journal of Risk and Insurance, 77(1), 155182.CrossRefGoogle Scholar
Macdonald, A.S. and Yu, F. (2010) How will screening for genetic disorders affect insurance?: A case study of colorectal cancer. Submitted.Google Scholar
MacMillan, J.C., and Harper, P.S. (1991) Single-gene neurological disorders in South Wales: an epidemiological study. Annals of Neurology, 30, 411414.CrossRefGoogle ScholarPubMed
Magee, A. and Nevin, N.C. (1999) The epidemiology of myotonic dystrophy in Northern Ireland. Community Genetics, 2, 179183.Google Scholar
Mathieu, J., Braekeleer, M. and Prévost, C. (1990) Genealogical reconstruction of myotonic dystrophy in the Saguenay-Lac-Saint-Jean area (Quebec, Canada). Neurology, 40, 839842.CrossRefGoogle ScholarPubMed
Medica, I., Marković, D., and Peterlin, B. (1997) Genetic epidemiology of myotonic dystrophy in Istria, Croatia. Acta Neurologica Scandinavica, 95(3), 164166.Google Scholar
Mladenovic, J., Pekmezovic, T., Todorovic, S., Rakocevic-Stojanovic, V., Romac, S. and Apostolski, S. (2005) Epidemiology of myotonic dystrophy type 1 in the population of central Serbia. Vojnosanitetski pregled, 62, 377382.Google Scholar
Mladenovic, J., Pekmezovic, T., Todorovic, S., Rakocevic-Stojanovic, V., Savic, D., Romac, S., and Apostolski, S. (2006) Survival and mortality of myotonic dystrophy type 1 (Steinert's disease) in the population of Belgrade. European Journal of Neurology, 13, 451454.CrossRefGoogle ScholarPubMed
Mor-Cohen, R., Magal, N., Gadoth, N., Achiron, A., Shohat, T. and Shohat, M. (1997) The lower incidence of myotonic dystrophy in Ashkenazic Jews compared to North African Jews is associated with a significantly lower number of CTG trinucleotide repeats. Israeli Journal of Medical Science, 33, 190193.Google Scholar
Mostacciulol, M.L., Barbujani, G., Armani, M., Danieli, G.A. and Angelini, C. (1987) Genetic epidemiology of myotonic dystrophy. Genetic Epidemiology, 4, 289298.CrossRefGoogle Scholar
Nesterov, L.N., Sushcheva, G.P., Viatkina, S., and Nesterova, I. (1983) Myotonic Dystrophy. Zh Nevropatol Psikhiatr Im S S Korsakova, 83, 16341641.Google ScholarPubMed
Osame, M. and Furusho, T. (1983) Genetic epidemiology of myotonic dystrophy in Kagoshima and Okinawa districts in Japan. Rinsho Shinkeigaku, 23, 10671071.Google Scholar
Paternak, J.J. (1999) Human molecular genetics. Fitzgerald Science Press, Bethesda MD.Google Scholar
Raeburn, A.J. (2000) Evidence given to the Human Genetics Commission. www.hgc.gov.uk/client/Content_wide.asp?ContentId=670, accessed on 20 May 2010.Google Scholar
Siciliano, G., Manca, M., Gennarelli, M., Angelini, C., Rocchi, A., Iudice, A., Miorin, M. and Mostacciulol, M. (2001) Epidemiology of myotonic dystrophy in Italy: re-apprisal after genetic diagnosis. Clinical Genetics, 59, 344349.CrossRefGoogle ScholarPubMed
Thomasen, E. (1948) Myotonia. Universitetsforlaget.Google Scholar
Wilkie, A.D. (2000) Report by the independent actuary on the application by the Association of British Insurers to the Genetics and Insurance Committee for approval to use genetic test results for insurance risk assessment — use of Huntington's disease test in life insurance. Genetics and Insurance Committee, Department of Health, London.Google Scholar
Yu, F. (2010) The financial impact of genetic information on the insurance industry. Ph.D Thesis. Heriot-Watt University.Google Scholar