Test & Treat : Changing the face of insurance for persons living with HIV?

Transcription

1 Test & Treat : Changing the face of insurance for persons living with HIV? Kadene Gibbs FSA, MSc Dr Matthew Procter

2 Agenda 1. Background 2. Understanding HIV and Factors affecting Prognosis 3. History of Test & Treat 4. Opportunities for Life Insurance 5. Further Refinements 6. Questions and Discussion

3 Background Global Prevalence Global estimates by WHO region 36.7 million South-East Asia Americas Europe Eastern Mediterranean Western Pacific living with HIV globally Africa

4 ART Coverage % Background Global ART coverage percentage 60% 50% 40% 30% 20% 10% 0% Calendar year African Region South East Asia Region Global net of African Region *UNAIDS/WHO, 2016

5 Background National Prevalence No. of persons with HIV No. of old diagnosis No. of new infections *UNAIDS/WHO, 2016

6 ART Coverage % Background National ART Coverage Percentage 60% 56% 50% 40% 34% 40% 45% 49% 30% 20% 10% 0% 27% 20% 15% 10% 7% 4% 1% 2% Calendar Year *UNAIDS/WHO, 2016

7 Background Hannover Re Prevalence Study Hannover Re partnered with Lancet All HIV tests done between 2009 to 2016 Data anonymized to Hannover Re researchers 2.2 million tests on unique individuals 275,000 positive tests observed

8 HIV Prevalence (%) Background Hannover Re Prevalence Study 25% 20% 15% 10% 5% 0% Calendar year Insurance Out-patient

9 HIV prevalence (%) Background Hannover Re Prevalence Study 25% 20% 15% 10% 5% 0% Age group Insurance Out-patient

10 HIV Prevalence (%) Background Hannover Re Prevalence Study 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Age group Males Females

11 Understanding HIV

12 Factors affecting HIV prognosis ART ADI and Co-morbidities Infection Route CD4 and Viral Load SEC

13 Test & Treat History CD4 < 200 WHO Stage 3 and 4 Illness Significant Symptoms CD4 < 350 WHO Stage 3 and 4 Illness HIV and Non- HIV related illness CD4 < 500 WHO Stage 3 and 4 Illness HIV and Non-HIV related illness

14 Test & Treat Current In treatment, strong evidence has emerged In treatment, strong to evidence show that using ART has emerged to show earlier that results in better using ART earlier results clinical better outcomes for clinical outcomes for people people living with HIV living with HIV compared compared with with delayed delayed treatment. treatment. - World Health Organization, World Health Organization,

15 Test & Treat History current CD4 < 200 WHO Stage 3 and 4 Illness Significant Symptoms CD4 < 350 WHO Stage 3 and 4 Illness HIV and Non- HIV related illness CD4 < 500 WHO Stage 3 and 4 Illness HIV and Non-HIV related illness CD4 at diagnosis Treatment recognised as prevention

16 Test & Treat History current 34% 45% 56% CD4 < 200 WHO Stage 3 and 4 Illness Significant Symptoms CD4 < 350 WHO Stage 3 and 4 Illness HIV and Non- HIV related illness CD4 < 500 WHO Stage 3 and 4 Illness HIV and Non-HIV related illness CD4 at diagnosis Treatment recognised as prevention Uninsurable risks ART programme Mortality and limited Morbidity risks Cover similar to standard life

17 Opportunities for Life Insurance Industry Mortality - Pricing Relative mortality risk (%) 1800% 1600% 1400% 15 X 1200% 1000% 800% 600% 400% 200% 0% < >=500 CD 4 count at diagnosis 3 X

18 Opportunities for Life Insurance Industry Mortality - Pricing Relative mortality risk (%) 900% 750% 600% 450% 300% 150% 0% < Age group SEC 4 SEC 3 SEC 2 SEC 1 *Illustration

19 Opportunities for Life Insurance Industry Critical Illness and Disability - Pricing Weighted average probability of condition-specific rates Weights = Expected claims distribution

20 Opportunities for Life Insurance Industry Critical Illness - Pricing Relative morbidity risk (%) Deriving relative risk rates for HIV+ lives Cancer Cardiovascular Neurological Other natural Non-natural 15 Standard Insured Life HIV+ Life

21 Opportunities for Life Insurance Industry Critical Illness - Pricing CI Claims Distribution 6% 14% Cancer Cardiovascular 6% 7% 4% 11% 52% Neurological Other Natural 29% 54% 17% Non-natural 30 to to 60 *Hannover Re Experience

22 Opportunities for Life Insurance Industry Critical Illness - Pricing Relative morbidity risk (%) Estimate of cost for HIV + lives Standard Insured Life HIV+ Life YEARS Standard Insured Life HIV+ Life YEARS Cancer Cardiovascular Neurological Other natural Non-natural

23 Opportunities for Life Insurance Industry Disability - Pricing Relative morbidity risk (%) 140% 120% 100% 80% 60% 40% 20% 0% Estimate of lump sum disability cost for HIV+ lives Standard Insured Life HIV+ Life YEARS Standard Insured Life HIV+ Life YEARS Musculoskeletal Neurological Other natural Cancer Mental and behavioural Non-natural Cardiovascular

24 Opportunities for Life Insurance Industry Underwriting vs. Pricing UNDERWRITING PRICING ADDITIONAL FACTORS Undetectable Viral Load? Age Not frequently used in Life insurance Gender No AIDS defining illnesses Socio-economic class Smoking status Duration on ART Infection route Good ART compliance CD4 at diagnosis vs current CD4 at treatment inception

25 Considerations EM loadings Relative Mortality Risk (%) 700% 600% 500% 400% 300% 200% 100% 0% Age Group Standard Life Flat RR of 300% Age Dependent Loading Per Mille *Illustration

26 Considerations ART Duration????? 0 Years 10 Years

27 Considerations Compliance

28 Summary Decline in mortality + morbidity over the years Better classify risks Test and Treat

29 Summary Opportunities

30 Questions & Discussion

31 References 1. Product Development in an HIV/AIDS Environment Stuart Land 2. Antiretroviral therapy and early mortality in South Africa Andrew Boulle et al 3. Mortality and causes of death in people diagnosed with HIV - Sara Croxford et al 4. Mortality According to CD4 Count at Start of CART Among HIV-infected Patients followed for up to 15 Years after Start of Treatment - Margaret May et al. 5. Incidence of Types of Cancer among HIV-Infected Persons Compared with the General Population in the United States, Patel et al 6. Risk of Cancer among Commercially Insured HIV-Infected Adults on Antiretroviral Therapy Lee et al 7. Increased Acute Myocardial Infarction Rates and Cardiovascular Risk Factors among Patients with Human Immunodeficiency Virus Disease Triant et al 8. Risk of coronary heart disease in patients with HIV infection Zanni et al 9. Comparison of Ischemic Stroke Incidence in HIV-Infected and Non-HIV-Infected Patients in a U.S. Health Care System Chow et al 10. Chronic Liver Disease in the Human Immunodeficiency Virus Patient Achara et al 11. Autoimmune diseases and HIV infection Virot et al 12. Update on HIV Dementia and HIV-Associated Neurocognitive Disorders Brew et al 13. Mid-year population estimates 2016 Statistics South Africa 14.