Liposomal Bupivacaine Optimizes TKA Economic Outcomes

New research has found that employing liposomal bupivacaine as part of an overall pain management program for knee arthroplasty patients can optimize clinical andeconomic outcomes.

The study, “Impact of treatment with liposomal bupivacaine on hospital costs, length of stay, and discharge status in patients undergoing total knee arthroplasty at high-use institutions,” appears in the November 30, 2018 edition of the Journal of Medical Economics.  

Co-author Carl Asche, Ph.D., with the Center for Outcomes Research at the University of Illinois College of Medicine, described the new study to OTW, “I believe the most interesting aspect of this study was that our primary outcomes were both clinical and economic.”

“For this analysis, we examined total opioid consumption, average hospital length of stay, total hospitalization costs and likelihood for patients to be discharged home. Our findings concluded that the addition of liposomal bupivacaine (EXPAREL from Pacira Pharmaceuticals, Inc.) to a multimodal analgesia program improved clinical and economic outcomes for primary TKAs [total knee arthroplasty] in the hospital setting.”

“In our study, we found that total hospitalization costs for TKA procedures were significantly lower for patients treated with liposomal bupivacaine compared to those who did not receive liposomal bupivacaine across both Medicare and commercial insurance groups. The total hospitalization costs for liposomal bupivacaine patients was on average $695.50 less than those who did not receive liposomal bupivacaine.”

“Findings from our multivariable analyses, that controlled for demographic and clinical variables, showed that overall length of stay was 0.6 days shorter for patients who received liposomal bupivacaine. Reducing length of stay positively impacts patients and hospitals alike—it gets patients home sooner, so they can begin the recovery process, and contributes to reduced total costs for hospitals.”

“Results from our multivariable analyses found liposomal bupivacaine patients were 1.6-times more likely to be discharged home in both the Medicare and commercial insurance groups. The benefits resulting from utilization of liposomal bupivacaine as part of a multimodal analgesia protocol, such as shorter length of stay and increased likelihood of discharge home, can lead to optimized economic outcomes for hospitals conducting these procedures.”

The authors wrote, “This retrospective observational study utilized hospital chargemaster data from the Premier Healthcare Database from January 2011 through April 2017 for the 10 hospitals with the highest number of primary TKA procedures using LB [liposomal bupivacaine]. Within these hospitals, patients undergoing TKA who received LB were propensity-score matched in a 1:1 ratio to a control group not receiving LB.”

Dr. Aschetold OTW, “In light of the nation’s opioid epidemic and increasing evidence that shows patients who receive opioids to manage postsurgical pain are at risk of addiction or dependence, it’s very important that patients in the EXPAREL arm demonstrated a significant decrease in opioid use.”

“Based on the findings of this study, orthopedic surgeons should strongly consider the integration of liposomal bupivacaine into their multimodal analgesia programs. We know that TKAs are typically incredibly painful procedures, and inadequate pain control can lead to delayed recovery and increased length of stay, likelihood of readmissions and total costs. Our results show that liposomal bupivacaine played a key role in optimizing patient, clinical and economic outcomes.”