(3) Clinical and health economic outcomes with and without liposomal bupivacaine in Medicare-insured patients undergoing outpatient shoulder arthroplasty

Background: : Total shoulder arthroplasty (TSA; anatomic and reverse) procedures have been progressively migrating away from inpatient settings toward hospital outpatient and ambulatory surgery venues, where effective perioperative pain management prior to discharge is critical. The NOPAIN Act has expanded reimbursement for qualifying nonopioid therapies, such as liposomal bupivacaine (LB), when used for Medicare-insured patients undergoing outpatient procedures. However, data regarding LB use for outpatient TSA in Medicare-insured patients are limited.

Objective: : To evaluate the impact of LB on opioid use and healthcare utilization for up to 12 months following TSA.

Methods: : Data on patients undergoing primary TSA with or without LB in hospital outpatient department settings from 2019-2021 were sourced from the 20% CMS-Medicare database (Parts A, B, and D). Cohorts were generated with 1:1 propensity score matching (PSM) between LB and non-LB groups. Opioid outcomes were evaluated in the pharmacy cohort (Part D) by chi-square test. Healthcare costs were evaluated using Wald tests via generalized linear mixed-effect regression for TSA and via zero-inflated Poisson regression for follow-up total medical and pharmacy costs.

Results: : Overall, 4100 patients were included in the analysis (LB, n=2050; non-LB, n=2050); patient characteristics were similar between groups after PSM (median age, 74 years; female, 55.4%; White, 92.9%; osteoarthritis, 94.4%). In the pharmacy cohort (n=3165), ~5% fewer patients in the LB group filled opioid prescriptions during the first week after TSA compared with the non-LB group (P < 0.01). This difference was primarily driven by significantly lower opioid use in opioid-experienced patients in the LB versus non-LB groups (P=0.007). Overall, relatively lower follow-up emergency department visits were observed in the LB group versus the non-LB group. These differences contributed to total cost savings after discharge of >$300 for LB compared with the non-LB group at months 3, 6, and 12. These cost savings offset the higher initial pharmacy costs of LB and contributed to an estimated ~$100 cost savings with LB over the 12-month follow-up period.

Conclusions: : Medicare-insured patients receiving LB for outpatient TSA experienced lower opioid use 1 week following surgery and had lower all-cause total healthcare costs over 1 year of follow-up compared with patients without LB, which may have been driven by more effective perioperative pain management. These data support the use of LB for outpatient TSA.

Sponsorship:: Pacira BioSciences, Inc.