Slide 1: Genetic testing anti-selection risk and implications for insurers
Genetic testing anti-selection risk and implications for insurers Florian Rechfeld Senior Research Analyst, Life & Health R&D, Swiss Re CRO Assembly, 31th May 2018
Slide 2: Trends and prospects in genetic testing
Trends and prospects in genetic testing CRO Assembly | Genetic Testing | May 31 2018 2
Slide 3: What is Genetic Testing?
What is Genetic Testing? “Genetic testing looks for alterations in a person's genes or chromosomes to identify heritable or acquired mutations related to disease and health” Diagnostic / confirmatory Pharmacogenomic testing Direct-to-consumer (DTC) genetic testing genetic testing Guides individual d
Slide 4: Declining sequencing costs and rapid growth of genetic tests
Declining sequencing costs and rapid growth of genetic tests Genetic Test development Genetic Testing Registry (GTR) • 54,538 Tests • 11,169 Disorders Plummeting genome sequencing costs and advances in human • 16,415 Genes genetics increases the availability for different types of genetic testing •
Slide 5: Genetic testing in the clinical practice has grown more than 20% annually
Genetic testing in the clinical practice has grown more than 20% annually in recent years Trend in UK clinical genetic testing activity 400000 Reported genetic tests 350000 300000 Number of reports 250000 200000 150000 100000 50000 0 Source: ACGS audits Advances in the understanding of human genetic
Slide 6: 23andMe & Co: A booming Direct-To-Consumer market
23and Me & Co: A booming Direct-To-Consumer market 40+ reports including: Polycystic Kidney Disease Cystic Fibrosis 23andMe customer development Hereditary Hearing Loss 5'000'000 5 reports including: BRCA1/2 (selected variants) NEW! 4'500'000 Late-Onset Alzheimer's Disease Parkinson's Di
Slide 7: Genetic testing frequency: US genetic testing consumer adaption rates
Genetic testing frequency: US genetic testing consumer adaption rates Source: https://rockhealth.com/reports/the- At least half of consumers open to taking a genetic test in the future as prices drop; most genomics-inflection-point-implications-for- healthcare/#consumer-sentiments, 2016, n=1060 to s
Slide 8: Use of genetic testing information in L&H insurance underwriting
Use of genetic testing information in L&H insurance underwriting CRO Assembly | Genetic Testing | May 31 2018 8
Slide 9: Key markets under regulatory pressure from banning genetic testing information
Key markets under regulatory pressure from banning genetic testing information for insurance underwriting Current regulatory approaches to insurers’ access and use of genetic data fall into 3 major categories: Legal ban Limitations by law No / Self-regulation Austria Germany Australia Belgium Nether
Slide 10: Predictive value of genetic tests and risk assessment
Predictive value of genetic tests and risk assessment CRO Assembly | Genetic Testing | May 31 2018 10
Slide 11: Insurance underwriting and risk classification
Insurance underwriting and risk classification Many factors that influence the risks of ill health or death may be used in insurance underwriting, based on statistical evidence. Such risk factors may include: • Non-medical factors: – Financials: occupation, income, sum assured, … – Habits: sport, tr
Slide 12: The risk for disease is multi-factorial: genetic and environmental components
The risk for disease is multi-factorial and depends on genetic and environmental components Genome Environment Genotype Non - Genetic Phenotypes Genotype Thrombosis Non - Genetic Schizophrenia Alzheimer Fam. breast cancer Diabetes Colon cancer syndrome Asthma Cystic Fibrosis Lung cancer Huntington’s
Slide 13: ACMG reporting of secondary findings from genome/exome-sequencing
ACMG reporting of “secondary” findings fromgenome/exome-sequencing • Minimum list of 59 genes and variants for 27 conditions to be returned whenever clinical exome sequencing is performed for any medical reason. • Medically "actionable" pathogenic variants with strong evidence for clinical validity
Slide 14: Genetic testing and anti-selection risk for insurers
Genetic testing and anti-selection risk for insurers CRO Assembly | Genetic Testing | May 31 2018 14
Slide 15: Future trends in genetic testing and insurance risk considerations
Future trends in genetic testing and insurance risk considerations Genome sequencing costs will continue to decline Genetic testing rates in the general population will continue to increase Associating future disease risk to specific gene characteristics will improve Regulatory restrictions on acces
Slide 16: Studies on genetic testing and its impact on insurance purchasing behaviour
Studies on genetic testing and its impact on insurance purchasing behaviour Genetic disease Insurance Odds ratio of over - insuring after Study (Gene) product positive test Armstrong et al.; 2003 Breast cancer (BRCA1/2) Life 5.1x more likely to increase coverage (USA) Alzheimer's disease LTC 5.7x mo
Slide 17: Modelling around the world - Attempt in quantifying the anti-selection impact
Modelling around the world - Attempt in quantifying the anti-selection impact Important model assumptions Proportion of population at risk for genetic conditions under study Proportion of population taking a genetic test each year Proportion of new applications if known to have higher genetic
Slide 18: Additional risk considerations for insurers
Additional risk considerations for insurers Disease incidence & over-diagnosis Adverse-selection Genetic tests used for screening Consumer’s knowledge of their genetic information (e.g. liquid biopsy) may lead to and future health increase in disease incidence & over-diagnosis. Insurance non-disclos
Slide 19: Reflections
Reflections • Scientific advances – clinical and over-the-counter genetic testing will continue its rapid growth • Regulations – increasing regulatory pressure restricting request and use of genetic tests and family history for insurance UW • Anti-selection – growing availability of predictive healt
Slide 20: Further information and client material on genetic testing
Further information and client material on genetic testing • Publications: – Seeing the future? How genetic testing will impact life insurance – Genomic Medicine – Personalised genetic testing and its impact to insurance CRO Assembly | Genetic Testing | May 31 2018 20
Slide 21: CRO Assembly | Genetic Testing | May 31 2018
CRO Assembly | Genetic Testing | May 31 2018 21
Slide 22: Legal notice
Legal notice ©2018 Swiss Re. All rights reserved. You are not permitted to create any modifications or derivative works of this presentation or to use it for commercial or other public purposes without the prior written permission of Swiss Re. The information and opinions contained in the presentati