Abstract
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.
Highlights
30 million people in the U.S have a liver disorder
All costs are expressed in 2014 U.S dollars (USD) and, where appropriate, were adjusted to 2014 USD using the Gross Domestic Product (GDP) deflator-based calculator [11]
Assuming the current environment of liver transplantation does not change over the 20 years, our first set of analyses predicts the total number of new patients on the waiting list will increase from 10,367 new patients in 2014 to 12,763 patients in 2033
Summary
About 40,000 of them will progress to end-stage liver disease, which is responsible for approximately 30,000 deaths annually in the U.S [1, 2]. In the U.S, the annual number of cadaveric donor livers decreased from 7,014 in 2006 to 5,798 in 2014, according to data collected by the Organ Procurement and Transplantation Network. Liver steatosis is increasingly common in donors and is a significant risk factor in liver transplantation [5]. These data point to one fact: Organ availability is an absolute constraint on the number of liver transplants that can be performed
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