Immunotherapy for mesothelioma – three key considerations for insurers

Head of Specialty Claims at Pro Global Michael Mackenzie shines the spotlight on ongoing immunotherapy research for treating mesothelioma, and the potential impact on asbestos related legacy claims.

There is mounting evidence that immunotherapy is effective in extending life expectancy for mesothelioma sufferers. Immunotherapy is an established, NICE-approved cancer treatment that stimulates the cancer patient’s immune system to kill mesothelioma cancer cells. This treatment has been successful for other cancers and is currently in clinical trials for its potential to treat mesothelioma.

With as many as 2,500 people facing a mesothelioma diagnosis in 2021, and thousands more already diagnosed, any advancements in treating and extending life expectancy for sufferers is welcome for individuals, families and society.

In February 2019, what is thought to be the first judgement on the issue of periodical payment orders (PPOs) as a mechanism for funding future immunotherapy in mesothelioma claims was handed down. The ruling was a clear signal to the insurance sector that the funding for immunotherapy treatments is covered by legacy insurance policies.

There are a number of considerations for insurers monitoring their EL / PL legacy books. Mesothelioma claims account for significant liabilities in the legacy space, and here are three key considerations that insurers and those carrying these legacy liabilities need to focus on when assessing their exposure and future claims:

Treatment options – immunotherapy looks set to become a mainstream treatment option for Mesothelioma. There are many factors which determine whether immunotherapy is a suitable treatment option and each case must be considered on its individual merits. Whilst standard principles can be applied to all claims, it is essential that insurers and their legal teams are aware of the various factors and characteristics of each case which can be balanced to determine the appropriate treatment options so as to ensure that indemnity spend is managed effectively. An example could be an offer to the claimant to take part in clinical trials for new anti-cancer agents. Strict criteria are set for the inclusion and selection of candidates – however, if selected, the cost of this treatment is covered by the study sponsor. Another example would be to ensure that the patient is suitable for any private treatment options being explored, medico-legal evidence can be secured to ensure the patients performance markers are such that immunotherapy and other emerging treatments are suitable treatment options.

• Impact – those patients who have received a diagnosis can secure immunotherapy treatment privately and those relevant costs can form part of their civil claim, with significant implications for claims costs. Experience shows us that when patients opt to seek private treatment, say for immunotherapy, this can lead to all of their treatment moving into the private sector. The cost implications for insurers are significant and it is essential that insurers understand these implications and re-calculate their reserves according. A recent development has been claims for combined therapies such as dual drug immunotherapy (i.e. ipilimumab and nivolumab) and the decision on single or double drug treatment will ultimately rest with the treating oncologist – with the cost being borne by insurer clients.

• Funding – various funding mechanisms are possible, however the funding arrangement adopted can also have significant cost implications. Insurers must be aware of the various funding options, and work with the Claimant’s legal representatives to agree and put in place appropriate arrangements, ensuring that those who wish to can access the most effective treatment in a timely, efficient and cost-effective manner. In addition, Pro has developed relationships with various treatment providers directly that deliver cost benefits to clients while expediting the treatment authorisation process for the claimant.

Please get in touch with the experts at Pro for more information.