The purpose of this two-part article is to look at biomarkers (with a focus on NT-proBNP) in use or under investigation in the medical world that are not currently widely used in the insurance market. We look at how we might use them in risk assessment methods, with an aim to improve experience, pricing and profitability. Consideration is given to how biomarkers can be used in the insurance environment, the problems in using these biomarkers, NT-proBNP versus the stress ECG and mortality and morbidity statistics.
IntroductionAccording to the American Cancer Society, the five-year relative cancer survival rates have risen from 55% in 1987-89 to 68% in the period 2003-09. Specifically, leukemia, myeloma, prostate cancer and NHL overall survival have improved by more than 15%1; however, ischemic heart disease, stroke and COPD remain the leading causes of death worldwide. The average life expectancy in 2012 of the global population was 70 years of age, up six years from 1990; the U.S. has added four years to its average age at death from 75 to 79, China is up from 69 to 75, the U.K. 76 to 81 and India 58 to 66 years of age12.
Discoveries in gene sequencing and enhanced diagnostic tools have pushed us into a new world of biomarkers and screening tests for a myriad of commonplace diseases. Biomarkers are indicators for processes that are involved in disease development and can be used for diagnosis, as an indicator of disease progression or to influence methods of treatment and management of disease. The insurance industry has already been using PSA as a screening tool for some time but there are still inherent problems in its application, since values can be raised for reasons other than prostate cancer. Any new test must be used in the appropriate context and the quality of the research data considered before implementing its use. As NT-proBNP is not used in clinical practice for screening purposes, the insurance industry is presented with a dilemma in how the biomarker should be used at the underwriting stage. For insurance purposes, we also need to consider the introduction of any new tests and the impact on the client, with the overall cost to the business.
Over-screening can lead to unnecessary worry, investigations and cost at the expense of business. The tests performed on clients should actually add value to the underwriting process and contribute to the overall profitability of the business. Our job is not to diagnose disease but to measure risk exposure of death or disease and to protect the book of underwriting business from undue losses. How we do this is defined by each company’s underwriting philosophy and stance in relation to screening tools. 45% of U.S. insurers were believed to be using NT-proBNP as a screening test in 20116, rising to 60% in 20137 and it is increasingly being used around the world in place of the stress ECG. Read More +