We had the pleasure of listening to many inspiring presentations about 3D Printing once again at the Materialise World Summit. One was by Philip Tack, a health economics researcher at Ghent University in Belgium. In his talk, "Health Economics: 3D is Here, But Can We Afford It Moving Forward?” Mr. Tack discussed the cost-effectiveness of medical innovations, more specifically, through a case involving a custom 3D-printed implant for a severe acetabular defect.
What is health technology assessment?
First, here's a brief description of health technology given by the WHO: "The application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives."
Mr. Tack started his presentation by explaining health technology assessment. In his words, what his team does with health technology assessment is to "systematically evaluate technologies to make decision-making easier.” The reason for these calculations is to determine the value of procedures that involve 3D Print healthcare technology in regards to costs.
Health economics – the values
To understand how health economics work, it's important to first have a grasp of some basics. A QALY (Quality-Adjusted Life Year) is a unit for determining the value of health outcomes. It factors in the length of life and quality of life. One QALY is equivalent to one year of perfect health. It's calculated by multiplying the length of life in a certain medical state, by the quality of life in that specific state (known as the utility value). Therefore, if a patient scores a utility of 0,5 for the duration of 10 years, the amount of QALYs is equal to 5.
The reason for calculating the QALY after each procedure is to understand its impact. One procedure, for example, could add two years to the original ten-year value, at a utility level of 0,5, thus increasing the QALY to 6. Another procedure could increase the utility value to 0,6 for the same original duration, thus resulting in a QALY of 6 as well. A procedure could also increase both values.
Health economics: to pay or not to pay?
Many players are involved in a medical procedure, and all are affected in different ways when it comes to costs. An evaluation is always based on a perspective. Eg: the perspective of the patient, the hospital, the doctors, the public healthcare provider,…
In his presentation, Mr. Tack shows a graph in which he explains the willingness to pay. The concept refers to the maximum cost allowed for a procedure, after which the health outcome will be higher than the current care.
On the vertical axis of the graph is the cost value, and on the horizontal axis are the QALYs. A point close to middle of the graph represents current care. Mr. Tack explains that if there is an innovation that generates less health than current care, regardless of the cost level, it will not be considered.
Then, there's the innovation that adds health. When the costs are lower than the current care point, the conclusion is clearly that the innovation will be used. The reality however is that when the health outcome is higher, the cost level is often also above the current care point.
The question then, according to Mr. Tack, is "What costs can we take for that health which is being generated?" In other words, what are we willing to pay?
Historically, says the health economist, the cost threshold is put at 50K USD for one QALY. If an innovation costs less, it's deemed cost-effective. If the cost is above, then it’s considered not cost-effective at the considered threshold. There’s a discussion among health economists as to whether the threshold should be raised to 100K USD or not.
Calculating the benefits of patient-specific 3D Printing
What data is used for all this? A lot of clinical evidence is gathered from clinical studies, health care insurance and government data, and then turned into usable data that is later used in a Markov model that calculates the cost-effectiveness. Every innovation is compared to the current state of a patient, says Mr. Tack.
Mr. Tack goes on to discuss a test case involving 3D Printing. Patient X was a 65-year-old male who needed a re-revision and had an acetabular Paprosky type IIIB defect that was severe and not easily treatable. The data was used in the modelling with the current standard of care, and with the new implant, says Mr Tack. In this case, the QALY was a little higher with the new aMace implant, than with the standard of care. The cost was higher as well, although the cost-benefit ratio was not above the threshold.
The main driver for the cost of the innovation was the cost of the implant, whereas for the standard care, the main cost driver was the complications. The model calculated the cost of one extra QALY with the new technology. "In this case we have an ICER (=Incremental Cost Effectiveness Ratio) of $17.000, which is way below the threshold," explains Mr. Tack.
He then shows more calculations done in many other cases involving patients of both sexes and varying ages. "In all those cases, when we calculate the ICER, when we had younger patients, it [aMace implant] would be cost-effective," tells Mr Tack. The results were less conclusive for older patients.
“To conclude we can say that this implant provides good value for money but only in cases where the subject is less than 85 years old. [In] our base case of a 65-year-old [the implant] was highly cost-effective.”
- Mr. Tack, Health Economics Researcher at Ghent University
How can we better understand the value of 3D Printing?
Scientific data for estimating the value of innovations is generally limited according to Mr. Tack. "It would be good to generate way more early data. [Some] health economists [suggest] to actually start reimbursement early on for a limited amount of time just to generate that evidence so we can check if that innovation is worth the cost,” he concludes.
According to Mr. Tack's health technology assessment, it is clear that patient-specific 3D-printed implants are cost-effective in complex cases involving acetabular implants where standard implants do not provide a solution, for patients up to an advanced age.
“We all know that innovations are the drivers of economies and make us move forward,” says Mr. Tack. 3D Printing technology for the medical field is an innovation that's already proven its value not only in cost, but also in quality of life. Embracing it and integrating it in standardized hospital workflows will likely drive patient care forward and contribute to a better and healthier world.