title: Long-term insured lives morbidity and mortality risk associated with chronic hepatitis C virus infection.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infects 170 million people worldwide. Some medical experts have suggested that progression to end-stage liver disease is inevitable; others have concluded that progression is restricted to a limited percentage of those who are infected. These opposing views have added to the uncertainty faced by underwriters who must assess risk in applicants infected with HCV. This article discusses use of a Markov model to estimate risk associated with chronic HCV infection in otherwise healthy applicants for life and critical illness insurance.
  
  
  RESULTS
  Estimated mortality ratios varied with assumptions regarding rate of progression from active HCV infection to cirrhosis. For males, peak mortality ratios decreased with advancing age at underwriting from a high of 209% (age 20) to a low of 122% (age 60). A similar age-related pattern was seen for females, from a peak mortality ratio of 184% (age 20) to a low of 128% (age 60). In contrast to the pattern of decreasing relative mortality at older ages, morbidity increased with age at underwriting. Sensitivity analysis indicated that calculations in the model were sensitive to different transition rates from active HCV infection to cirrhosis and from cirrhosis to hepatocellular carcinoma (HCC) but not sensitive to treatment frequency and success. A review of the literature also suggested that a favorable prognosis was likely in applicants with persistently normal alanine aminotransferase (ALT) levels, but prognosis was less certain for those with intermittent or persistent elevation of liver enzymes.
  
  
  CONCLUSIONS
  Morbidity and mortality are within the insurable range for the majority of HCV-infected persons. Risk varies with gender, age at infection, and other variables discussed in the article.
authors.affiliation: Worldwide Medical Research and Development, General-Cologne Re, Financial Centre, PO Box 300, 695 East Main Street, Stamford, CT 06904-0300, USA. pokorski@gcre.com
authors.forename: R J
authors.initials: RJ
authors.lastname: Pokorski
mesh_terms: D000328:Adult; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007352:Insurance, Life; D008103:Liver Cirrhosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D020379:Risk Adjustment; D014481:United States / Q000453:epidemiology