Crafting a Tailor-Made Bone – Leveraging 3D Printing in Healthcare
Explore the crafting process of customized titanium bone for orthopedic surgeries & its potential impact to the overall healthcare sector.
Since 1984, 3D printing has revolutionized the world and currently plays a more active role than just rapid prototyping. With 20-year continuous improvement, its applications range from home appliances, electronic devices, to even critical-and-high-precision jet engines.[1] Now, 3D printing is ready to tap into healthcare and shake this booming sector.
Trauma is becoming a leading cause of death in many developing countries worldwide which in turns skyrocketed demand for orthopedic surgeries. The general treatment for patients who suffered severe trauma that require bone implant surgery would be to cut partial of patient’s pelvis bone and use such part in operation. The alternatives would be to purchase pre-casted bone or obtain the replacement piece from cadaver. However, despite the difficulties in obtaining substitute bone piece, the acquired substitute may be incompatible with patient’s body which leads to future complications.
Meticuly, found in 2017, is the startup based in Thailand that employ sophisticated 3D printing technique to craft titanium bone for orthopedics bone implant surgeries.[2] Unlike other exotic metal used in advance applications (aerospace, high-temperature) such as cobalt and stainless steel, titanium is the generally accepted material in medical treatment due to its fine mechanical properties and high resistance to chemical reactions inside human body. The crafting process started by a CT scanning of patient subject’s bone to develop a 3D model. The Meticuly engineer then conduct a finite element analysis to incorporate 3D image with bone’s mechanical properties. Since each of the 206 bone pieces in human body serves unique mechanical functions and varies from patients to patients, there is no one-bone-fit-all. After finalizing the 3D model with orthopedist, the titanium bone is crafted using special 3D printing technique. Layer by layer, the powerful optic laser beam fuses the titanium powder into a solid form. Finally, if necessary, the bone goes through heat treatment process to further improve mechanical properties. The entire process takes around 2 to 7 days which is substantially shorter than the other alternatives.[3]
The crafted titanium bone benefits both patients and orthopedists in a remarkable manner. From patient perspective, complications arise from chemical incompatibility of traditional bone implant can be severe that countless future operations would be required; mechanical and dimension incompatibility could also create stress to tendon and tissues around the area and deteriorate physical function of that part of the body. These issues are potentially resolved with the Meticuly’s solution. In addition, the relatively short time for bone crafting means patients can be treated in a timely manner and results in lower probability of complications. From orthopedist perspective, the lesser the time patients required to remain in hospital, the higher the patient’s turnover. Lower complication rate of discharged patient also reduces the workload of orthopedists in the long run which is crucial for Thailand where ratio of orthopedist is 1 to every 50,000 population.[4] It is fascinating that this tiny piece of titanium bone could potentially shake the entire healthcare sector of the country.
The on-going debate around healthcare technology always come to the issue of cost, but, surprisingly, the Meticuly team can achieve the production cost comparable to that of the imported pre-casted counterpart. The demand for implant bone in Thailand is high due to extremely high rate of traffic-related accidents, ranked top of the world in 2017 with 22,356 deaths and 100,000 injured.[5] Still, majority of patients cannot afford the treatment and it is not included in the social welfare program. Since majority of Meticuly production costs are associated with orthopedists and engineers, achieving cost reduction through economic of scale could be challenging. The team is currently working with orthopedists in major hospitals across the country to gain wider acceptance, and with representatives from ministry of public health on potential future change of social welfare program. Another challenge is that this product is still in early phase of adoption. Though approval from Thai FDA was granted, it is too early to conclude that crafted titanium bone could entirely substitute traditional methods. Aiming to solely scale product too fast may result in ethical issue. Finally, as with all early phase startups, the company has limited funding.
As of May 2018, the Meticuly team achieve deliverables of 20 out of 206 bone models for 30 patients. Word of mouth spread the existence of Meticuly as more and more orthopedists reached out to the team. Still, cost issue remains a constant concern. One potential direction the company could take is to adopt a semi-tailor-made model, which could reduce cost associated with specialists by producing a more generic model that suits physical characteristics of Thai people. Although it is not totally aligned with Meticuly primary goal, this direction may help the team achieve economic of scale faster. What levers should the team take to navigate the company through the challenging early adoption phase? (797 words)
[1] Harvard Business Review, “3D Printing Is Already Changing Health Care”, Mar 4 2016, https://hbr.org/2016/03/3d-printing-is-already-changing-health-care?autocomplete=true, accessed Nov 2018
[2] The Momentum, “Titanium Bone for Orthopedic Surgery by Thai People for Thai People”, Jun 18 2018, https://themomentum.co/boonrat-lohwongwatana-meticuly/?fbclid=IwAR2Z6Y8X5r_yQA8zhCg7N_LZyHfsFSizN8Bo3M_cL1FGmdzZlSOZYaeiBZo, accessed Nov 2018
[3] NBT World, “Thailand Today 187: Custom-made artificial bones using titanium 3D-printing technology”, Jul 5 2018, https://www.youtube.com/watch?v=glAMBCEY2_8&feature=youtu.be&fbclid=IwAR2xGSgdeOmaoZHD57Dma6ZQn9UOcjRJcTgdabHDfybmBwBB1Fsg8bIMQfo, accessed Nov 2018
[4] Clin Orthop Relat Res., “Musculoskeletal Trauma Service in Thailand”, Jul 16 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584308/, accessed Nov 2018
[5] BLT Bangkok, “Thailand Continues Reign as World’s Top Country with Highest Road Accident”, Dec 28 2017, http://www.bltbangkok.com/CoverStory/%E0%B9%84%E0%B8%97%E0%B8%A2%E0%B8%84%E0%B8%A3%E0%B8%AD%E0%B8%87%E0%B9%81%E0%B8%8A%E0%B8%A1%E0%B8%9B%E0%B9%8C%E0%B9%80%E0%B8%AA%E0%B8%B5%E0%B8%A2%E0%B8%8A%E0%B8%B5%E0%B8%A7%E0%B8%B4%E0%B8%95%E0%B8%9A%E0%B8%99%E0%B8%96%E0%B8%99%E0%B8%99%E0%B8%A1%E0%B8%B2%E0%B8%81%E0%B8%97%E0%B8%B5%E0%B9%88%E0%B8%AA%E0%B8%B8%E0%B8%94%E0%B9%83%E0%B8%99%E0%B9%82%E0%B8%A5%E0%B8%81, accessed Nov 2018
This technology seems like it could substantially change trauma surgeries as we know it, across the globe. A few ideas for how to scale include starting with a generic model, using similar past constructions as a starting point, having simpler bones designed by newer folks. Additionally, it seems that Meticuly has a strong value proposition and is in the position to change the lives of many, across Thailand and the globe. In order to scale the company should secure additional funding and try to partner with larger hospital systems. Ideally this would enable an exchange of ideas between top surgeons (product users) and would enable word of mouth marketing to other hospitals and regions.
Great read, PK! It is fascinating to see how 3D printing can play an important role in healthcare by making tailored bones and other kinds of tissues. Besides the important social impact that this technology brings, building a sound and scalable business is still challenging. Making partnerships with governments or non-profits focused in healthcare innovation can be useful for companies to strive in their early stage while they prepare for growth. To your point, for this technology to reach scale, it is important to keep on researching new material and processes that could make 3D printing cheaper.
It’s interesting to see 3D printing being used in the healthcare industry. It’s unfortunate that cost seems to always be a gating issue with anything in this industry. How are people paying for the existing treatment options? Do insurance companies cover those and can you negotiate with them to include this new treatment in people’s existing insurance coverage? I do agree that you need to achieve economy of scale first in order to generate enough interest among government, investors and insurance companies. However, I also do worry about long term effects of this treatment that we just haven’t had enough time to observe yet.
Thank you for this insight – it is interesting to see applications of 3D printing expand to the healthcare space. With all these new inventions, one important point you touched upon and that I will explore further is how to ensure that the masses can benefit from these new solutions. Driving production costs down to those of alternative solutions is only the first step. What counts is the overall cost of treatment – so as a next step I believe it is key that Meticuly establishes strategic partnerships with hospitals to figure out how to drive overall costs of treatment down through improved treatment efficiency – in the long run, this will also benefit Meticuly who can then become the primary provider of their product.
PK, thanks for sharing! It’s interesting to see how 3D printing is used in healthcare. I believe it has huge benefit for future. For the cost challenge you mentioned, I am thinking of: can they use less skilled orthopedists and engineer or less expensive materials to reduce the cost? Can insurance be leveraged to cover the cost? They can think of partnership at this early adoption stage, such as government, NGO, special funds. Once this stage was passed and a bigger scale is achieved, there would be great economy benefit I believe.
Costs are certainly a key issue when it comes to 3D printing in healthcare – especially considering these medical practices often need to hire additional employees with more technical backgrounds. Additionally, many surgeons need to spend additional time training to learn how to use this new software and hardware (which is time away from working at the top of their license). Eventually, the hope is that the costs can be significantly reduced given the trends in printer and material pricing, along with the potential that this process can become automated. Do you think the costs associated with 3D printing will ever reduce costs on the system? This is especially relevant in some new payer models where reimbursements can be tied to outcomes metrics and time driven costing.