Treadmill value in apparently healthy life insurance applicants

The objective of this study is to assess the cost/value tradeoff of a routine treadmill requirement for life insurance applicants. For this purpose, we are interested in the treadmill's ability to provide unique information on the mortality risk in a population of apparently healthy and asymptomatic individuals, as opposed to the treadmill done for diagnostic or confirmatory purposes.

We performed a protective value study, solving for the face amount at which the mortality savings outweigh the various treadmill requirement costs. Multiple scenarios were evaluated, varying the following assumptions: percent of cases uniquely discovered through the treadmill, excess mortality associated with the treadmill, proportion of would-be applicants ending the process when confronted with a treadmill requirement, proportion of not-takens in the face of a positive treadmill, and various profitability requirements. While there is an array of information available from the treadmill, to avoid double counting effects we chose 2 representative and independent findings: abnormal ECG and low fitness (duration). Prevalence of findings and mortality associations were derived from published studies.

While many companies are moving to eliminate or restrict the use of treadmill testing, low break-even policy sizes were produced in virtually every iteration of our assumptions. In one variation, however, we ignored the possibility of any "fitness" findings. Under this assumption, results were roughly consistent with current industry practice. This suggests that some companies could enhance the value of their treadmill requirements by requesting Balke protocol treadmills and/or interpreting duration information. Others may want to reconsider current face amount thresholds for their treadmill requirement in light of this valuable risk-selection information.