Abstract 14849: Lifetime Benefit of Empagliflozin in Extending Survival Free From Insulin Initiation in Type 2 Diabetes and Cardiovascular Disease: An Actuarial Analysis of EMPA-REG OUTCOME

Background: Many patients with type 2 diabetes (T2D) will, over time, require insulin therapy for glycemic control. Treatment-attendant adverse effects of insulin such as weight gain and hypoglycemia may be especially problematic in those with CVD. Delaying the need for insulin initiation may therefore be an important therapeutic goal, especially in those with CVD. Methods: This actuarial analysis evaluated the 3,633 (52%) of 7,020 EMPA-REG OUTCOME participants who were not using insulin at baseline. Patients were randomized to the SGLT2 inhibitor empagliflozin (EMPA) 10mg, 25mg, or placebo (PBO). After the first 12 weeks, changes in background antihyperglycemic therapy were allowed. We estimated survival time free from insulin initiation (sustained over ≥2 consecutive study visits) over patients’ lifetimes by using baseline age as the time horizon. Age-based Kaplan-Meier survival curves were constructed for each year of age between 45 and 80 years. Differences in area under the survival curve between treatment arms represented treatment effects on time spent alive and free from insulin initiation. Results: During median follow-up of 3.2 years, insulin was required in 172 patients (7.1%) with EMPA and 196 (16.4%) with PBO. Lifetime benefits on insulin-free survival were inversely related to baseline age, ranging from 1.4 to 11.3 years. For a 45-year-old, estimated insulin-free survival was 20.1 years with EMPA and 10.0 years with PBO (difference: 10.1 years; 95% CI 5.7-14.5 years; P<0.0001). At age 60 years, insulin-free survival was 16.7 vs. 10.5 years (difference: 6.2 [4.6-7.8]; P<0.0001), and at age 75 years, 9.7 vs. 8.1 years (difference: 1.5 [0.0-3.1]; P=0.056). Conclusions: Assuming stable lifetime effects, we estimate that initiation of EMPA prolongs time alive free from need for insulin by 1.4 to over 11 years among adults with T2D and CVD. While benefits were most pronounced among younger patients, EMPA reduced the need for insulin across a broad age range.

Some actuarial mathematical models for insuring the susceptibles of a communicable disease

Using epidemiological and actuarial analysis, this paper formulates some new actuarial mathematical models, called S-I-DR-S models, for insuring the susceptibles of a population exposed to a communicable disease. Epidemiologically, the population is structured into four demographic groups, namely: susceptibles [Formula: see text], infectives [Formula: see text], diseased [Formula: see text] and recovered [Formula: see text], with the latter automatically re-entering the group of susceptibles [Formula: see text]. The insurance policies are targeted at the members of the susceptible group who face the risk of infection and death due to the disease. Using actuarial techniques and principles, we determine some interesting features of the model, namely, (a) financial obligations of the parties, (b) present value of premiums, (c) quantum of claims by infected policy holders (PHs), (d) quantum of claims on behalf of deceased PHs, (e) cumulative insurance reserve for annuity and (f) lump sum plan. To check the risk of insolvency, premium adjustment for the PHs is also considered.

Construction of c-credibility measure and application in insurance

Credibility theory provides a tool for modelling various phenomena in insurance. Changes in life circumstances such as the pandemic and its consequences require adjustment of old and creation of new theories that would improve existing parameters in modelling phenomena in insurance and actuarial analysis. Thus, by using c-credibility measure, we try to respond to some of the challenges that have emerged. The paper presents a summarised theory of c-credibility and gives an algorithm for constructing c-credibility measure, which is illustrated by an example.

Análise Atuarial da Idade Ótima de Aposentadoria Frente à Proposta do Governo Temer de Reforma da Previdência: Uma Revisão da Literatura / Actuarial Analysis of the Retirement Optimal Age Faced with the Government's Temer of Pension Reform Proposal: A Literature Review

Este trabalho é parte de uma pesquisa que tem como objetivo encontrar a idade ótima de aposentadoria no Regime Geral da Previdência Social (RGPS), tomando como base as alterações trazidas na PEC 287/2016. Para isso, foi realizado uma revisão na literatura, em base de dados e livros e periódicos, a fim de fomentar as discussões acerca do tema. Como este estudo encontra-se em fase de conclusão, serão apresentados resultados intermediários de sua fundamentação teórica, que trazem um histórico da Previdência Social, com as reformas mais significativas para o RGPS e suas falhas; versa sobre o contexto de surgimento da PEC 287, seus critérios para obtenção dos benefícios e a fórmula do cálculo; além de discutir sobre os fatores que influenciam na tomada de decisão pela aposentadoria. A PEC 287 trouxe critérios mais rigorosos para concessão dos benefícios, e isso gera dúvidas na população que tem a dimensão financeira influenciando diretamente na sua decisão pela aposentadoria.