How Cost Effective are 3D Printed Adaptive Aids for Arthritis Patients?

Millions of people are affected by arthritis, a chronic condition consisting of physical disability and joint pain that can negatively affect the patient’s life. But not only is the condition painful, it is also costly in terms of medical care and expenses that aren’t covered by insurance, such as adaptive aids to help with tasks such as opening jars. These aids are helpful, but much more expensive than conventional products. Using digital technologies, like desktop 3D printing, in the distributed manufacturing of goods has been growing more popular when it comes to lowering costs. Low cost medical devices, experimental equipment and lab equipment have already been shown to be feasible and affordable. Will the same be true of adaptive aids?

Arthritis patients would definitely benefit from a cost reduction of adaptive aids, which is where a trio of researchers from Michigan Technological University come in. Nicole Gallup, Jennifer K. Bow, and Joshua M. Pearce completed a study, titled “Economic Potential for Distributed Manufacturing of Adaptive Aids for Arthritis Patients in the U.S.,” that evaluated if distributed manufacturing, by way of 3D printing, would be economically viable for fabricating lower cost adaptive aids for arthritis.

The abstract reads, “By 2040, more than a quarter of the U.S. population will have diagnosed arthritic conditions. Adults with arthritis and other rheumatic conditions earn less than average yet have medical care expenditures that are over 12% of average household income. Adaptive aids can help arthritis patients continue to maintain independence and quality of life; however, their high costs limit accessibility for older people and the poor. One method used for consumer price reduction is distributed manufacturing with 3-D printers. In order to assess if such a method would be financially beneficial, this study evaluates the techno-economic viability of distributed manufacturing of adaptive aids for arthritis patients.“

The study focused on aids for arthritis of the hands, as these are the most likely candidates for 3D printing. The team used common, inexpensive PLA to fabricate 20 adaptive aids on low-cost desktop 3D printers – specifically delta-style RepRap Athena II kits from Michigan’s 3D4EDU – to determine their distributed manufacturing costs. 

All of the adaptive aids were found for free on open source 3D printing design website MyMiniFactory, sliced with the recommended settings on Cura, and the open source 3D printers were run with no heated beds or enclosures to keep the cost down, as well as to ensure realistic mechanical properties and operating conditions. With the exception of manual support material removal and assembly, no other post-processing was required.

The 20 adaptive aids included items that would be able to help users complete such everyday tasks as splitting pills, clipping their nails and brushing their teeth, zipping up jackets and opening up pop cans, and turning on a light switch.

The researchers chose the adaptive aids based on six criteria:

1. They had freely available STLs posted on MyMiniFactory.
2. They contained the source code for straightforward device customization.
3. They were licensed with an open-source compatible license or designer requests as defined by the Open Source Hardware Association.
4. They could be fabricated on a consumer grade 3D printer.
5. They were able to be 3D printed and used if manufactured from PLA.
6. They had a functionally equivalent commercialized proprietary product, or a clear application for arthritis patients.

“These products were tested for function and compared to those that offer similar functions on the U.S. market,” the researchers wrote. “These results are evaluated to determine the potential for distributed manufacturing to assist arthritis patients and conclusions are drawn.”

The researchers found that each adaptive aid was in fact “able to perform the technical mechanical function for which it was designed,” but determined that further work is necessary in order to find out where the devices would be most applicable in terms of patient populations. Then, they set about determining the overall cost of 3D printing the 20 assistive aids.

Filament costs and labor costs were excluded, and the actual 3D printing time was also not a factor, because “the filament cost dominates the operating costs and the printers can be comfortably operated without observation or labor intervention.”

“The energy use of the 3-D printer was found to be about 40 W during printing,” the researchers stated. “With energy use during translation (movement without printing of the head) and warming up to printing temperature included, the 3-D printer uses about 0.06 kW/h or less than 1 penny per hour to operate.”

The researchers also massed all of the 3D printed components after printing and post-processing was complete to help with the economic comparison. But, while the mass is pretty dependent on the slicing settings, the cost of a single aid will only vary by about 10% from new user setting variations, which changes the percent savings but doesn’t hurt the conclusions.

“For example, the toothbrush aid had a mass of 69.55 g. If it was printed with a mass of 76.5 g (a 10% increase) it would result in a cost of US$1.53, which is a 91.8% savings rather than 92.5%,” the researchers explained.

As it turns out, using distributed manufacturing to 3D print adaptive aids can actually save arthritis patients a decent amount of money.

“The financial savings for the patients ranged from 86.3–98.5% per product manufactured with a consumer desktop 3-D printer, with average savings of  over 94%. Overall, the 20 example adaptive aids could be printed for a 1 kg of plastic, which costs $20, while on average each single adaptive aid would save the patient more than $20,” the researchers concluded. “3-D printing all 20 adaptive aids would save about $400, which means only 30 adaptive aids alone could fully cover the capital cost of the printer along with the filament and electricity costs.”

This means that Medicare patients could potentially 3D print their own adaptive aids for less money than their 20% co-payments on prescribed DMEs.

“Policy makers as well as philanthropists should consider funding the open-source design of arthritis aids that have not already been developed,” the researchers concluded. “As arthritis is going to be an even more prevalent problem in the future, the application of distributed manufacturing represents a means to economically help society adapt to some of the increased costs associated with the disease.”

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