Barrett's esophagus is associated with an increased risk of adenocarcinoma of the esophagus.
Despite this increased risk, most cohort studies demonstrate that the mean life expectancy of subjects with Barrett's esophagus is no different than age-matched controls.
The indirect costs associated with a diagnosis of Barrett's esophagus are unclear.
Dr Shaheen and colleagues assessed the effect of a diagnosis of Barrett's esophagus on insurance premiums.
The researchers assessed 20 national life insurance companies (10 in southern California, 10 in North Carolina) to determine the effect of a diagnosis of Barrett's esophagus on life insurance premiums.
The investigators’ base case in Los Angeles was a 36 year old female nonsmoker, and in North Carolina, a 43 year old Caucasian male nonsmoker, both in excellent health except for a diagnosis of prevalent Barrett's esophagus with no dysplasia.
The investigative team then requested a policy of 20 year guaranteed term life insurance in the amount of $1,000,000.
|Companies refused to provide health insurance to the individual with Barrett's esophagus or requested further medical review|
| The American Journal of Gastroenterology |
Companies were asked for their best price exclusive of the Barrett's esophagus, and also their best price when considering Barrett's esophagus as a preexisting condition.
The researchers subsequently sent a physician's letter explaining Barrett's esophagus and providing data substantiating a normal life expectancy in the condition to those companies not offering the "preferred" rates.
The team also asked companies for health insurance quotes, including premiums and deductibles, inclusive and exclusive of the diagnosis of Barrett's esophagus.
The investigators contacted 29 national insurance companies and for the 43 year old man with no Barrett's esophagus, the yearly "preferred" premium for life insurance averaged $1,255.
The mean cost of the policies offered to the same individual with Barrett's esophagus as a preexisting condition was $2,731.
The researchers noted that for the 36 year old female the base rate exclusive of Barrett's esophagus was $517, with a range of $472 - $551.
After inclusion of the diagnosis of Barrett's esophagus, the mean rate rose by 177%, to $1,434, with a range of $1,144 - $1,896.
The investigators reported that companies either refused to provide health insurance to the individual with Barrett's esophagus or would not provide a quote without review of the medical record.
The team observed that none of the insurance companies changed their quoted rates after receiving the letter written by the physician on behalf of the individual.
Dr Shaheen concludes, “Despite the preponderance of data demonstrating a normal life expectancy associated with the condition, a diagnosis of Barrett's esophagus more than doubles life insurance premiums, and impacts the availability of health insurance.”
“Further steps to educate insurance companies about the risks associated with Barrett's esophagus are warranted, and patients should understand this additional "risk" of endoscopic screening for Barrett's esophagus.”
“There are significant indirect costs associated with a diagnosis of Barrett's esophagus.”