Future Economics of Liver Transplantation: A 20-Year Cost Modeling Forecast and the Prospect of Bioengineering Autologous Liver Grafts.
Future Economics of Liver Transplantation: A 20-Year Cost Modeling Forecast and the Prospect of Bioengineering Autologous Liver Grafts.
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DOI：
10.1371/journal.pone.0131764
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Soto-Gutierrez A
中科院分区：
文献类型：
--
作者：
Habka D;Mann D;Landes R;Soto-Gutierrez A
在过去的 20 年中，肝移植已成为儿童和成人最严重类型的肝衰竭和肝细胞癌的最终治疗方法。在美国，大约有 16,000 人在肝移植等待名单上。由于器官短缺，只有38%的人会接受移植。本文探讨了另一种选择：生物工程自体肝移植。我们开发了一个 20 年模型，预测未来肝移植的需求以及基于当前技术的成本。我们将这些成本预测与生物工程自体肝移植的预计成本进行了比较。该模型分为：1）流行病学模型预测候补患者数、手术患者数和术后患者数； 2) 模拟期间的治疗模型预测成本（移植前相关成本；移植（入院）相关成本；以及移植后 10 年相关成本）。使用终末期肝病模型评分对患者群体进行分类。等待名单上的患者数量预计将在 20 年内增加 23%，而肝移植前阶段的加权平均治疗费用预计将在 20 年内增加 83%。预计对肝脏的需求将在 10 年内增加 10%，在 20 年内增加 23%。肝移植总费用预计 10 年内将增加 33%，20 年内将增加 81%。相比之下，根据当前 iPS 衍生肝细胞的目录价格，生物工程自体肝移植的预计成本为 970 万美元。该模型预测，由于供体肝脏供应有限，未来 20 年供体肝脏的需求和成本将持续增加。在等待名单上死亡的患者人数将反映出这种不断扩大的差距。目前，生物工程自体肝移植的成本高昂。然而，随着新的制造策略和规模经济的引入，成本将迅速下降。
During the past 20 years liver transplantation has become the definitive treatment for most severe types of liver failure and hepatocellular carcinoma, in both children and adults. In the U.S., roughly 16,000 individuals are on the liver transplant waiting list. Only 38% of them will receive a transplant due to the organ shortage. This paper explores another option: bioengineering an autologous liver graft. We developed a 20-year model projecting future demand for liver transplants, along with costs based on current technology. We compared these cost projections against projected costs to bioengineer autologous liver grafts. The model was divided into: 1) the epidemiology model forecasting the number of wait-listed patients, operated patients and postoperative patients; and 2) the treatment model forecasting costs (pre-transplant-related costs; transplant (admission)-related costs; and 10-year post-transplant-related costs) during the simulation period. The patient population was categorized using the Model for End-Stage Liver Disease score. The number of patients on the waiting list was projected to increase 23% over 20 years while the weighted average treatment costs in the pre-liver transplantation phase were forecast to increase 83% in Year 20. Projected demand for livers will increase 10% in 10 years and 23% in 20 years. Total costs of liver transplantation are forecast to increase 33% in 10 years and 81% in 20 years. By comparison, the projected cost to bioengineer autologous liver grafts is $9.7M based on current catalog prices for iPS-derived liver cells. The model projects a persistent increase in need and cost of donor livers over the next 20 years that’s constrained by a limited supply of donor livers. The number of patients who die while on the waiting list will reflect this ever-growing disparity. Currently, bioengineering autologous liver grafts is cost prohibitive. However, costs will decline rapidly with the introduction of new manufacturing strategies and economies of scale.