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Focussed on Choice
Crayola Colour Chart 1903-2010
cTn Assay
Diagnostic Cutoff
1995
Tnl
1.5 ng/mL
2003
cTnl
0.1 ng/mL
2007
Tnl_Ultra
0.04 ng/mL
Cancer
ICD-O-2 to ICD-O-3
Borderline
Malignant
18 Terms
Malignant
Borderline
24 Terms
Sources:
Bhoi, S., Verma P., Vankar S., Galwankar S. High Sensitivity Troponins and conventional troponins at the bedside. Int J Crit Illn Sci 2014;4: 253-6
Guidelines for ICD-O-3 Implementation, 2000, North American Association of Central Cancer Registries, accessed 30 October 2015
<https://www.facs.org/~/media/files/quality%20programs/cancer/coc/naaccr.ashx>
Source: The 2011 Diagnostic Guideline for Alzheimer's Disease US National Institute of Aging/ Alzheimers Association , 2011, The Hong Kong Medical Association, accessed 30 October 2015 <
http://www.hkma.org/english/cme/onlinecme/cme201112main.htm >
There will be
Overdiagnosis
Testing capabilities are increasingly sensitive
Detecting disease that may otherwise never be diagnosed
Leading to overdiagnosis
0.1%
Source: Welch H & Black, W.,Overdiagnosis in Cancer , J Natl Cancer Inst 2010; 102:605-613
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There will be
Overdiagnosis
Overdiagnosis will impact insurers even if there are no population
based screening programs
Condition
Level of Overdiagnosis
Asthma
ADHD
Breast Cancer
Prostate Cancer
Lung Cancer
Thyroid Cancer
Moynihan R., Doust J., Henry D., Preventing Overdiagnosis: how to stop harming the healthy, BMJ 2012;344:e3502
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12
: CDC Foundation et al, The Global Adult Tobacco Survey, 2015, World Health Organisation accessed 30 September 2015, <http://www.who.int/tobacco/publications/surveillance/gatstlas/en/>
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There will be
Reserving Issues
We will start seeing the impact of second and subsequent
benefits
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There will be
Reserving Issues
Multipay CI = (1+P(Bi|Ai))* P(Ai)
P(Bi|Ai) driven by complications, progressions and
shared risk factors.
For pricing the result is a X * X matrix of risks
First Event : Cancer
Complications
Progressions
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There will be
Reserving Issues
However
Claim reserves for 2nd and subsequent claims are set
when first claim is paid
For reserves E(Bx|Ax) E(B|A)
2nd claims Reserves should be related to ALL known information about the
individual policyholder.
EG. First Event : Major Burn
However through the claim process you also know they now have dangerously high hypertension
Reserves should be set appropriately.
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Cardiac death with symptoms suggestive of myocardial ischemia and presumed new ischemic ECG changes or
new LBBB, but death occurred before cardiac biomarkers were obtained, or before cardiac biomarker values
would be increased.
Percutaneous coronary intervention (PCI) related MI is arbitrarily defined by elevation of cTn values (>5 99th
percentile URL) in patients with normal baseline values (99th percentile URL) or a rise of cTn values >20% if
the baseline values are elevated and are stable or falling. In addition, either (i) symptoms suggestive of
myocardial ischemia or (ii) new ischemic ECG changes or (iii) angiographic findings consistent with a procedural
complication or (iv) imaging demonstration of new loss of viable myocardium or new regional wall motion
abnormality are required.
Stent thrombosis associated with MI when detected by coronary angiography or autopsy in the setting of
myocardial ischemia and with a rise and/or fall of cardiac biomarker values with at least one value above the
99th percentile URL.
Coronary artery bypass grafting (CABG) related MI is arbitrarily defined by elevation of cardiac biomarker
values (>10 99th percentile URL) in patients with normal baseline cTn values (99th percentile URL). In
addition, either (i) new pathological Q waves or new LBBB, or (ii) angiographic documented new graft or new
native coronary artery occlusion, or (iii) imaging evidence of new loss of viable myocardium or new regional wall
motion abnormality.
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C53
Grading System for Dysplasia, Pathology Department of Shantou University Medical College, accessed 30
20
October 2015, < http://pathol.med.stu.edu.cn/pathol/listEngContent2.aspx?ContentID=634>
Goldstones S., Diagnosis of Treatment of HPV-Related Squamous Intraepithelial Neoplasia, 2005, The PRN Notebook, accessed 30 September 2015
<http://www.prn.org/images/pdfs/82_goldstone_stephen.pdf>
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Time
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Products Require
Collaboration
Organisations that are collaborative and utilize collective
intelligence will be best placed to lead
Similarly actuaries who are collaborative will be best
placed to understand and manage this highly important
product into the future.
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What We Do
How we do this
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Q&A
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Thank you