Alternative Medical Markers – Promising but More Research Needed
July  2012

​​​​​​​​​​​​​​The Society of Actuaries (SOA) and several other associations commissioned a study last year to examine alternative medical markers for their potential use in mortality assessment. The report, prepared by Milliman with the assistance of the major medical labs, compared the usefulness of various laboratory tests against total cost (Figure 1). The study’s findings suggest that a number of tests in use today can provide companies with net mortality savings.

Figure 1: Medical MarkersNet Mortality Savings
MarkerAges labs recommend for testingNet mortality savings      (male age 70,
$100,000 face)
Total       cost for marker test
Apo A-1 and B40+$33.70$21
RDW60+$193.44$17
Cystatin C55+$272.29$19
Hemoglobin65+$558.76$20
Hemoglobin A1c35+$151.95$19
Microalbumin35+$148.60$23
NT-proBNP60+$407.64$37
Oxidized LDL45+ (male)
55+ (female)
$104.65$27
Lp-PLA245+$45.77$25
TNF-alpha50+$199.09$11
Troponins I and T55+ (Male)
65+ (female)
I: $114.13 T: $186.54$31

Underwriting time per test is a significant portion of the estimated savings. NT-proBNP is seeing more use by carriers. One reason could be that the test is relatively quick to access (average two minutes, 15 minutes for abnormal cases).

Many carriers understand the value of the NT-proBNP test as a possible indicator of coronary-artery disease, especially among older-age applicants. Companies have also identified hemoglobin A1c as a promising marker for adult-onset diabetes. Adding these and other medical markers to existing blood panels may provide additional protective value.

The SOA report itemizes the potential total cost of administering a test, including not only the cost of the test itself, but also costs associated with necessary underwriter training and interpretation after factoring an assumed not-taken rate. These costs range from $11-$37 per application.

The authors do not discuss any price efficiencies gained by combining tests, nor do they provide recommendations. In some situations, a direct correlation to mortality was not available and in these cases the authors used estimations or reasonable proxies. More research will be necessary to develop more precise mortality correlation coefficients.

Certain medical tests may be more useful to some carriers than others, based on management strategies and target market. NT-proBNP is associated with reduced left ventricular function and possible cardiovascular disease. In recent years carriers have been interested in using the test in underwriting, especially for older-age cases. Yet older tests like TNF-alpha have yet to win acceptance despite their initial promise. Some markers have only been tested against a general population such as the Social Security Administration’s Death Master File (DMF) or the third National Health and Nutrition Examination Survey (NAHANES III). Further study is needed to see if the markers retain their value against an insured population.

The major labs are already working with direct writers to assess the protective value of some of these tests in an insured population. Several labs have begun marketing proprietary risk assessment “scorecards” based on these and other blood panel factors to help underwriters reach a decision more quickly.

As risk partners, reinsurers have a vested interest in supporting direct writers’ underwriting decisions. We recommend that direct writers consult with their reinsurers before using such risk assessment tools to place business on which they seek reinsurance coverage. SCOR Global Life Americas looks forward to collaborating with clients to gauge how these and other future underwriting developments can improve bottom-line claims experience.