Socio-economic Dynamics of Adoption of Additively Manufactured Patient-Matched Knee Implants

1. The socio-economic dynamics of the adoption of additively manufactured (3D printed) patient-matched knee implants Amir Namin, Mohammad Jalali, VahabVahdat, Jacqueline Isaacs SD-Ph.D. Colloquium, WPI Dec 1, 2017

2. Introduction Problem Motivation Results Model Development Summary 3D Printing: key trend of Smart Manufacturing Additive Manufacturing/3D printing refers to a process by which digital 3D design data is used to build up a component in layers by depositing material.

3. Introduction Problem Motivation Results Model Development Summary 3DP Application in medical Industry Source: Thomson et al. Manufacturing Technology 2016 In the medical and dental industries, AM can be used to produce a wide variety of personalized products such hearing aids, biosensors, bespoke, hip and knee joints..

4. Introduction Problem Motivation Results Model Development Summary 3DP for Knee Implants • Reduce wear on a knee implant: • 1 millimeter per year to about 1/10 of a millimeter • Provide: • more efficiency and value for patients

5. Introduction Problem Motivation Results Model Development Summary Benefits of customized implants: Patient Outcome Pain After Surgery Functional Limitation Early Implant Failure Source: eos-alphaform, http://additivemanufacruring.com 2015

6. Introduction Problem Motivation Results Model Development Summary Benefits of customized implants: Economics 63,173 re-admitted patients (Medicare Beneficiaries) in 2014 Medicare paid $645.3 million for these readmissions alone. 400,000 THA & TKA procedures (for Medicare Beneficiaries) costs federal government more than $7 billion just for hospitalizations In United States by 20301,2: 174% increase in demand for hip replacement 674% increase in demand for knee replacement 23% increase in Revision Hip 39% increase Revision Knee THA: total hip arthroplasty TKA: total knee arthroplasty = 1.5 x Total Joint Replacement (TJR) has been targeted for cost and quality control by the Center for Medicare and Medicaid Services (CMS)as one of the high volume and cost procedures.1 Big changes coming for hip, knee surgery payments • 1) Ramos NL, et al. (2014) Source: eos-alphaform, http://additivemanufacruring.com 2015 Ventola CL. 2014

7. Introduction Problem Motivation Results Model Development Summary Motivation • What are the dynamics of diffusion of the new technology and product among the patients and physicians? • What policies could increase the diffusion of this technology? • What are the impacts of insurance policies on the diffusion of the new product?   • What are the barriers slowing down the adoption of the new technology? Addressing the following questions via System Dynamics: 

8. Model Development high level CLD (Causal Loop Diagram) P-M: Patient-Matched/ Customized

9. Model Development high level CLD P-M: Patient-Matched/ Customized OTS: Off-The-Shelf

10. Model Development high level CLD P-M: Patient-Matched/ Customized OTS: Off-The-Shelf

11. Model Development high level CLD P-M: Patient-Matched/ Customized OTS: Off-The-Shelf

12. Model Development high level CLD P-M: Patient-Matched/ Customized OTS: Off-The-Shelf

13. Model Development high level CLD P-M: Patient-Matched/ Customized OTS: Off-The-Shelf

14. Introduction Problem Motivation Results Model Development Summary Validation Tests Performed • Dimensional consistency • Equation robustness • Extreme conditions • Parameter assessment • Structure assessment • Behavior validity • Behavior reproduction • Sensitivity analysis

15. Introduction Problem Motivation Results Model Development Summary Model Calibration TKA: total knee arthroplasty

16. Introduction Problem Motivation Results Model Development Summary Design/perform scenario & policy analysis Based on the two main factors slowing down the adoption • Insurance Coverage for PM • OTS sales force influence on surgeons Insurance Policies 1(20%) 2(50%) 3(80%) Scenario and Policy analysis have been designed and performed Scenario1Scenario2 Scenario3 (High) (Medium) (Low) (Initial OTS sales force influence)

17. Introduction Problem Motivation Results Model Development Summary Effect of insurance coverage & sales influence on adoption Insurance Coverage • Adoption reduced at high OTS sales influence High Impact Low Impact

18. Introduction Problem Motivation Results Model Development Summary Effect of insurance coverage & sales influence on cost savings

19. Introduction Problem Motivation Results Model Development Summary Effect of insurance coverage on adoption & recovery % of Patients using PM % of Patients using OTS % of OTS Patients % of PM Patients & Manufacturer willingness % of OTS Patients % of PM Patients

20. Introduction Problem Motivation Results Model Development Summary Summary • Greater adoption rate of P-M: • high possibility to improve patient outcome • shorten recovery time and hospitalization • reduce number of revision surgeries & readmissions • While • Save a lot of money for the healthcare system • Recovery cost has the most contribution (35%-58%) to the total cost • decreasing the time of recovery would have the most impact on cost savings • More insurance coverage for P-M (at each scenario) would ultimately lead the system to more cost savings

21. Room for improvement… • Any missing mechanism? • Any other model/analysis improvement? Suggestions for… • Choice of policy to analyze? Acknowledgments • T. Astor (MGH) • S. Kamarthi (Northeastern University) • W. Kurtz (Joint Replacement & Revision Surgery, Nashville, TN) • T. Pietila (Materialise) • A. Sharma (University of Tennessee) Amin T. Namin anamin@coe.neu.edu