title: Caution in the use of the apolipoprotein E e4 allele as a predictor of healthcare costs.
abstract: Healthcare payers of all types are interested in accurately predicting future costs. The e4 allele of the gene coding for apolipoprotein E on chromosome 19 (e4 allele) is a potentially attractive genetic marker. This could be used to set insurance premiums or determine whether an insurance policy is actually underwritten because it is a susceptibility marker for Alzheimer's disease, heart disease and stroke. There is some evidence that the apolipoprotein E e4 allele is associated with healthcare costs. However, caution is warranted given the limited number of studies that associate the e4 allele and cost, and concerns regarding selection bias in studies that show an association between the e4 allele and occurrence of costly diseases. Until more is known, the e4 allele should not be used to approve or deny issuance of insurance or to set premium rates for either acute or long-term care insurance.
authors.affiliation: Terry Sanford Institute of Public Policy, Center for Health Policy, Law and Management, Duke University, Durham, NC, USA. dtaylor@hpolicy.duke.edu
authors.forename: Donald H
authors.initials: DH
authors.lastname: Taylor