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Model projects increase in need, cost of donor livers over next 20 years

In a new cost and treatment model, researchers found that the demand of donor livers, along with treatment costs, will increase rapidly over the next 20 years.

The researchers developed a 20-year model, The Epidemiology Model and the Treatment Costs Model, to project future demand for liver transplants and costs based on current technology. The model was divided into two parts: the epidemiology aspect investigated population dynamics of liver transplantation, including patients who were wait-listed, underwent transplant and postoperative patients up to 10 years, whereas the treatment model looked at projected costs, including pre–transplant-related costs; admission-related costs; and 10-year post–transplant-related costs, during the simulation period. The patient population was categorized using the MELD score.

Based on the epidemiology model, the number of new patients on the transplant wait list will increase from 10,367 new patients in 2014 to 12,763 patients in 2033, which represents a 23% increase in the total number of patients on the waiting list over 20 years. These findings were based on the current liver transplantation environments remaining the same throughout this period.

These findings were then compared with the percentage of patients with nonidentified or nonindicated MELD scores on the Organ Procurement and Transplantation Network (OPTN) database and those with inactive status. The number of new patients on the wait list with a MELD score is predicted to increase from 7,934 new patients in 2014 to a maximum of 8,006 new patients in 2020, before decreasing to 7,600 new patients in 2033, according to the research.

“This decrease does not reflect a decrease in demand for liver transplantation,” the researchers wrote. “It reflects the classification of the data reported to the OPTN database and our decision to exclude patients with no reported MELD score.”

Between 2014 and 2033, the number of patients with a MELD score less than 9 will decrease by 55%; patients with a MELD score between 10 and 19 will decrease by 27%; patients with a MELD score between 20 and 29 will increase by 15%; patients with a MELD score between 30 and 39 will increase by 42%; and patients with a MELD score greater than 40 will increase by 76%.

In the treatment model, the researchers found that treatment for a patient in the pre-liver transplantation phase will cost between $49,407 and $613,020 at 1 year. It is projected to increase to between $71,621 and $867,564 at 20 years. The average treatment costs in the pre-liver transplantation phase are predicted to be $168,386 at 1 year and will increase by 83% by 20 years, with an average treatment cost of $307,610. For a patient in the admission phase, the average treatment cost will increase by 42% between 1 year and 20 years and increase from $588,580 to $836,788. For a patient examined 10 years post-transplant, the average treatment cost will increase from $670,839 to $949,391 from 1 to 20 years.

Taking all phases into consideration, the total average treatment costs of a liver transplantation will increase from $1,427,805 per patient at 1 year to $2,093,789 per patient by 20 years. 

“Projected demand for livers will increase 10% in 10 years and 23% in 20 years,” the researchers wrote. “Total costs of liver transplantation are forecast to increase 33% in 10 years and 81% in 20 years.”

The researchers also examined the development and use of induced pluripotent stem (iPS)-derived liver cells in liver transplantation. They projected the costs of manufacturing a liver from iPSCs to be $27,715,000 for the entire liver, $9,710,000 for 35% of the liver and $4,170,000 for 15% of the liver. These projected costs are based on current catalog prices for iPS-derived liver cells.

To date, bioengineering autologous liver grafts is cost prohibitive, the researchers wrote. However, costs will likely decrease as an introduction of new manufacturing strategies and as economies of scale occurs.

“Creating a universally available liver graft from autologous tissue and cells would increase the number of organs available for transplantation and eliminate the need for a life-long regimen of immune suppression drugs and their complications,” the researchers wrote. “Clearly there is a compelling social need to perform liver transplantation more widely. Now that many of the scientific elements are falling into place, it will likely be possible to bioengineer a liver from autologous cells.”

The researchers stated: “The simple truth is that significantly more livers are needed for transplantation. According to clinicians, thousands more could benefit from a transplant but are precluded from the waiting lists because they have not yet reached critical status. The shortfall of organs is predicted to rise in the coming decades given the increasing prevalence of liver-damaging viruses, a surge in fatty liver disease, and a buildup of environmental toxins.” – by Melinda Stevens

Disclosures: Habka reports receiving fees to develop the 20-year cost modeling forecast by Solving Organ Shortage. Please see the full study for a list of all other authors’ relevant financial disclosures.