An actuarial model of arrhythmogenic right ventricular cardiomyopathy and life insurance

Many countries ban insurers from using genetic test results in underwriting. One study [Howard, R. C. W. (2014). Report to CIA research committee: Genetic testing model: If the underwriters had no access to known results. Canadian Institute of Actuaries (CIA).] stated that such a ban in Canada would expose life insurers to adverse selection, causing premiums to increase by 12%. More than a quarter of this cost was attributable to a single disorder, Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). We model ARVC in a life insurance market, following the methodology of [Hacariz, O., Kleinow, T. & Macdonald, A. S. (2021). Genetics, insurance and hypertrophic cardiomyopathy. Scandinavian Actuarial Journal 2021, 54-81.], including 'cascade' genetic testing (CGT), so the role of family history in underwriting is modelled explicitly. We review (in the Appendix) the published epidemiology of ARVC, in particular the existence of an effective treatment, which we also include in our model. Our results are consistent with those of [Macdonald, A. S. & Yu, F. (2011). The impact of genetic information on the insurance industry: Conclusions from the 'bottom-up' modelling programme. Astin Bulletin 41(02), 343-376.] and [Hacariz, O., Kleinow, T. & Macdonald, A. S. (2021). Genetics, insurance and hypertrophic cardiomyopathy. Scandinavian Actuarial Journal 2021, 54-81.], namely, that in realistic scenarios premium increases would be negligible. We also consider the possibility of life settlement companies 'gaming' insurers by learning of adverse genetic test results, and conclude that to profit from purchasing policies from affected individuals, they would have to predict the future trajectory of the epidemiology of ARVC better than the epidemiologists themselves.