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• The potential impact on the insurance industry of predictive genetic tests is determined by a complex interplay of factors related to the genetic test itself, engagement with testing, the genetic architecture of the condition, the capacity for reducing risk and the cost of treatment.
• Health-related reasons motivate individuals to undergo predictive genetic testing, but the extent to which people act on genetic test results or share them with healthcare providers and insurers appears to be limited.
• Key factors that may change the impact of genetic tests are better characterisation of genetic risk, development of new interventions, and increased test access.

Predictive genetic testing provides individuals with information about their future risk of developing health conditions. Theoretically, predictive genetic tests could have positive or negative impacts on the insurance industry. If genetic test results stimulate actions to reduce health risks, they may reduce costs to insurers. If disclosed to insurers, such information may allow them to better understand individual- and population-level risks and make insurance more affordable. However, if individuals who know they are at high genetic risk of becoming ill or dying are more likely to apply for insurance than those not at high risk, this may lead to an unanticipated increase in claims. It may be exacerbated if people at low genetic risk are less likely to apply for insurance compared to the general population. If this happened on a large scale it could make the insurance market unsustainable. Determining whether a genetic test could affect the insurance industry is complex and needs to be evaluated on a per-test basis.

The Cambridge Centre for Health Services Research, a collaboration between RAND Europe and the University of Cambridge, developed a framework for evaluating the potential impacts on the UK insurance industry arising from predictive genetic tests. It considers the characteristics of genetic tests and behavioural aspects that influence their uptake. It is intended to provide a transparent approach for evaluating whether a specific condition for which a test is available could impact the insurance industry, currently or in the future, and understanding the key factors that influence this.

• Chapter One

  Background to the study

• Chapter Two

  Methodological approach

• Chapter Three

  REA of motivations for predictive genetic testing and its impact on health-related behaviours

• Chapter Four

  Expert perspectives on current and future developments in predictive genetic testing

• Chapter Five

  Framework for evaluating the risks presented by genetic tests to the UK insurance industry

• Chapter Six

  Summary, reflections and suggestions for future research

• Annex A

  Data collection template for the development of the draft framework

• Annex B

  Expert interview protocol

• Annex C

  Search Strategy for the REA

• Annex D

  Inclusion and exclusion criteria for REA

• Annex E

  Data extraction fields for the REA

• Annex F

  Reviewed studies for the REA