3d-printing

Our first blog of 2017, titled ‘12 medical technology innovations likely to transform healthcare in 2017’ looked at the technologies that we believe will have the greatest impact on the continued transformation of healthcare. This week’s blog by Amen Sanghera, an analyst here at the Centre, takes a deeper dive into 3D printing technology and its current and future uses across the healthcare and life sciences industry.

Frankenstein’s Lab
During the course of studying for my master’s degree in 2013, I worked in a small manufacturing lab towards the top floor of a busy North London hospital. In many ways it resembled how you might imagine Doctor Frankenstein’s lab to have looked; the benchtops of the lab and the walls of adjacent corridors were proudly adorned with jars displaying their contents of ears, noses and ‘vascular conduits’. However, unlike Frankenstein’s lab, the body parts displayed here were fashioned from novel polymers produced by an array of 3D printers.

Though still experimental, the work occurring in this lab aims to reconstitute patient tissue lost or damaged by diseases such as cancer or injuries relating to burns. Essentially, researchers take scans of a patient’s tissue, transfer those to computer-aided-design (CAD) software and then print that design to make a scaffold out of ‘biocompatible’ polymers. The printed scaffold is then ‘seeded’ with the recipient’s own stem cells, with the aim that it will create functional tissue to be surgically transplanted back to the patient. In this endeavour, the coming of age of 3D printing has been a revolutionary step in the manufacturing of truly personalised therapies; it is quicker, cheaper and more accurate (at mimicking the structure of tissues) than the methods preceding it.

Continued Innovation
Since I graduated in 2014, 3D printing (additive manufacturing) has continued to make significant progress, with far reaching and rapidly evolving uses in healthcare. Indeed, analysts’ projections place the size of the 3D printed healthcare market between $1.2 billion and $2.3 billion USD by 2020.1,2 Some of the innovative uses in healthcare include:

  • the creation of customised prosthetics and implants - in 2016, the Food and Drug Administration (FDA) approved the use of two 3D printed titanium spinal implants3, which are carefully designed to accommodate the vertebral anatomy and aid in the restoration of proper sagittal balance in the lumbar spine.4 In more mainstream applications 3D printing is revolutionising the production of hearing aids through reducing the manufacturing process from nine to three steps. More than an estimated 10 million hearing aids have been manufactured using 3D printing technologies5
  • the production of accurate anatomical models - in 2015, surgeons at a UK hospital used 3D printing to create an anatomical replica of a paediatric patient’s trachea for use prior to a ‘lung washing’ treatment. The model allowed anaesthesiologists to practice their surgical technique and ascertain the correct sized equipment to use prior to the surgery, thereby increasing efficiency and lowering the risk to the patient.6 Additionally in late 2015, UK surgeons used 3D printing to aid them in the transplantation of an adult kidney to a child; this was done by creating models of the kidney to be transplanted and the child’s abdomen7
  • the construction of tissue and organ fabrication - though still at an experimental stage, the bioprinting of human tissue is expected to be an enabler of regenerative medicine and a solution to the shortages of tissues and organs needed for transplantation. Examples of this technology include the printing of skin8 and other more complex organ tissues such as the kidney, although currently with limited functionality.9 In early 2016, a US research team 3D printed tissues that closely mimic the structure and function of a human liver. It is hoped that this technology can be used to do pilot studies for patient-specific drug screening and disease modelling, enabling pharma companies to focus on the most promising drug candidates earlier, reducing R&D time and costs while accelerating routes to market10
  • manufacturing of medical and surgical instruments - in the Gaza Strip, a small team is producing low cost 3D printed stethoscopes for use in the poorest hospitals and clinics in the region.11 Meanwhile, surgeons in Spain have begun creating their own 3D printed devices that are tailored to fit the patient they are treating. Currently, they have used these custom instruments in 30 complex cardiothoracic surgeries12
  • pharma research including new drug fabrication methods to improve drug dosing, delivery and discovery - Benefits include not only the customisation and personalisation of drugs, but also cost-effectiveness, increased productivity and enhanced collaboration.13 Indeed, the first 3D-printed prescription drug received FDA approval in 2015 for use in treating seizures with the technology enabling companies to make fast-dissolving, easily ingested formulations of high-dose medications, in a single pill.14

All Round Savings
With healthcare systems across the world feeling the pinch of budgetary constraints, 3D printing technology can provide a way to improve efficiency and cost-effectiveness. Examples include:

  • in December 2016, a UK a start-up teamed up with the NHS to reduce the cost burden of providing prosthetics to patients. The start-up uses 3D printing to produce bionic hands that cost £5,000, significantly cheaper than the usual cost of £30,000 to £60,00015
  • in 2014, a US product development company demonstrated that 3D printed injection moulds can cut the production time of certain medical devices by 95 per cent and their associated costs by 70 per cent compared to traditional aluminium moulds16
  • the open-sourced nature of the technology allowing patients in the most remote areas access to inexpensive medical care.17 Indeed, in 2014 an American non-profit was able to produce prosthetic limbs for Sudanese victims of war in six hours for as little as £60.18

Despite the advances highlighted above, 3D printing technology still has some fundamental challenges to overcome. One big test is whether a simpler digital workflow can be made for creating and printing 3D objects. But if simplified software can make it easier for physicians and surgeons to interact with digital models, then 3D printing will undoubtedly find its way into hospitals, and other healthcare providers. There is also the issue as to whether 3D printed products can be manufactured at scale, and the perceived regulatory issue which is often presented as also an obstacle to widespread adoption. However, as identified in our recent report Unravelling complexity: The challenge of compliance in the life sciences supply chain, the FDA has released draft guidance for manufacturers interested in produced 3D-printed medical devices and is working directly with industry to help identify and address potential roadblocks and eliminate potential delay in the adoption of promising new technologies.19 Other barriers that also need to be overcome include:

  • continued investment to increase the number of printers required to facilitate mainstream surgical use
  • scientific advances to allow for more sophisticated metal materials to be printed and gain approval for human contact
  • achieving good consistency between printed products.

Conclusions
These challenges notwithstanding, the potential promise of 3D printing technology is huge; given its use in a broad spectrum of applications, from providing inexpensive solutions for low- and middle-income countries to expensive bespoke solutions in high-income countries. A happy medium between the two is still to be reached, but evidence to support its widespread use continues to be promising. In the coming year, 3D printing will continue to offer a number of improvements across the global healthcare industry, with enormous potential in the longer-term.

Amen-Sanghera

Amen Sanghera -  Research Analyst, Centre for Health Solutions

Amen is a Research Analyst at the Centre for Health Solutions, the independent research arm of Deloitte LLP’s healthcare and life sciences practices. His remit is to use primary and secondary research and rigorous analysis to develop insights that inform stakeholders across healthcare and life sciences about emerging trends, challenges, opportunities and examples of good practice. Amen has a background in healthcare market research where he has authored several reports on the current and future state of medical devices and pharmaceuticals markets, such as coronary stents and contrast media. Amen also holds an MSc in Nanotechnology and Regenerative Medicine from University College London.

Email | LinkedIn

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1 http://www.prnewswire.com/news-releases/3d-printing-in-healthcare-market-to-reach-usd-12-billion-by-2020---industryarc-research-575697751.html
2 https://www.alliedmarketresearch.com/press-release/3d-printing-healthcare-market.html
3 http://www.3ders.org/articles/20160601-k2m-receives-fda-approval-for-two-more-3d-printed-titanium-implant-systems.html
4 http://www.k2m.com/products/product/cascadia-an-lordotic-oblique-interbody-system/
5 https://www.forbes.com/sites/rakeshsharma/2013/07/08/the-3d-printing-revolution-you-have-not-heard-about/#6e7327c1a6b5
6 https://www.theengineer.co.uk/issues/sept-2015-online/3d-printing-helps-nhs-surgeons-practice-tricky-procedure/
7 http://www.guysandstthomas.nhs.uk/news-and-events/2016-news/january/20160125-Worldfirst3Dprintingusedinlife-changingkidneytransplant.aspx
8 http://www.wakehealth.edu/Research/WFIRM/Research/Military-Applications/Printing-Skin-Cells-On-Burn-Wounds.htm
9 https://www.technologyreview.com/s/602691/3-d-printed-kidney-parts-just-got-closer-to-reality/
10 http://ucsdnews.ucsd.edu/pressrelease/engineers_3d_print_a_new_lifelike_liver_tissue_for_drug_screening
11 https://3dprint.com/95097/project-glia-gaza-strip/
12 https://3dprint.com/158215/3d-printed-surgical-instruments/
13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071603/
14 http://medcitynews.com/2016/12/3d-printing-impact-healthcare/
15 http://www.hitcentral.eu/british-journal-healthcare-computing/nhs-partners-3d-printing-start
16 http://investors.stratasys.com/releasedetail.cfm?ReleaseID=879379
17 https://www.theguardian.com/technology/2017/feb/19/3d-printed-prosthetic-limbs-revolution-in-medicine
18 http://www.wired.co.uk/article/impossible-not-printing-artificial-limbs
19 https://www2.deloitte.com/uk/en/pages/life-sciences-and-healthcare/articles/unravelling-complexity.html

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