Impact of Genomics on Insurers - Part 5
Shall we manipulate the genes of an unborn?
Day by day, our understanding of how genetic variations influence health is growing. First therapies based on interventions at the level of individual genes are on the market and further ones will follow. How will this trend influence the insurance industry?
What is gene therapy?
Gene therapy is a treatment method in which a section of DNA is altered to treat a genetic disease. DNA sections can be introduced into the cells of patients, where they act as a blueprint for the protein production of those cells thereby, driving the production of proteins with therapeutic effects or replace a defective strand of DNA.
Depending on the targeted cell type, we distinguish between two types of gene therapy. In somatic gene therapy, a section of DNA is transferred into the somatic cells of the body, i.e. cells that do not produce sperm or egg cells. In this case, the effects of gene therapy are unlikely to be passed down to the patient’s children. In germline gene therapy, a section of DNA is transferred into reproductive cells, i.e. cells that produce egg or sperm cells. Thus, effects of gene therapy can be passed down to the patient’s descendants.
Earliest techniques of gene therapy were first developed in 1972. However, it was not until 1990 when gene therapy was successfully applied to the first human patient: a four-year-old girl with a life-threatening congenital disease called adenosine deaminase deficiency combined with immunodeficiency.
There are several approaches for gene therapy, which differ in the molecular mechanism triggered in the targeted cells. These mechanisms are described in the following table and exemplarily explained in the figure below.
Gene therapy has been arising controversy along several dimensions.
The first topic dividing the minds of doctors and researchers are the risks of gene therapy at the level of the individual patient. Although successful treatments are known and diseases such as Duchenne muscular dystrophy and cystic fibrosis can be treated by gene therapy, side effects are sometimes unpredictable. Even if a disease can be treated successfully, other mutations may potentially be introduced.
There are also ethical questions being debated. The controversy arose in the first place because of the possibility to alter germline cells. While gene therapy can theoretically spare future generations of family certain genetic diseases, it may possibly also affect the development of the fetus and lead to unexpected side effects. Because the affected unborn is unable to decide whether to undergo such a treatment, ethical concerns are undisputed. Further, germline gene therapy could be used for selecting characteristics beyond medical conditions, such as intellectual or athletic abilities as well as physical appearance or personality traits. Once available and accepted, this could start an arms race in a population as those who can afford it would certainly make use of it in order not to fall behind others – while those who cannot (or do not want to) afford it would be left behind, eventually leading to an increased gap between the wealthy and the poor. The same would apply on the level of whole nations. Hand in hand goes the fear that humans with certain disabilities or diseases would be less accepted in a society where the use of gene therapy is widespread.
To avoid the outcomes mentioned above, some nations are setting up regulatory bodies. The following table gives an overview of selected countries:
Lastly, gene therapy is currently still expensive. Two recent therapies brought to the market have been priced at nearly half and nearly a full million USD per treatment, respectively (Kymriah from Novartis, which targets a subtype of leukemia, and Luxturna from Spark Therapeutics, which targets a rare form of blindness). However, the lifetime costs of treating a chronic disease the classical way at the symptom level may be even higher, in particular as with many chronical diseases, there might arise «additional costs», such as loss of productivity of the patient and in some cases also relatives. Nevertheless, the high one-off costs for gene therapy certainly present a significant challenge for payers – both in public and private health systems.
Impact on insurers
Gene therapy provides various interdependent opportunities and threats for insurers.
Gene therapy treatments are typically very specific as they intervene at or close to the molecular root cause of an illness. As a result, they can be very effective but are typically rather expensive due to the smaller target group they have been developed for.
On the one hand, both life and health insurers will profit from a longer average human lifespan due to better treatments as these stretch customer lifetime and hence premium volume. On the other hand, the impact on claims costs per insured is unclear and may also depend on the type of coverage. For example, claims costs of health insurers could increase in the medium term due to more expensive treatment costs, but they may sink on the long-term due to more effective treatments as well as gene therapy becoming more of a commodity that is available at lower cost than it is today. The impact on claims costs on life insurers depends strongly on the types of coverage in their books - as different types of life insurance are differently affected by an increase in longevity.
Synpulse is currently conducting an online survey with insurance experts on the impact of genomics – including gene therapy – on insurers. Later articles in this series will present our findings. Stay tuned!