(4) Impact of liposomal bupivacaine on healthcare resource utilization and costs in patients undergoing total knee arthroplasty in real-world ambulatory surgical centers

Background: : Total knee arthroplasty (TKA) is increasingly performed in outpatient ambulatory surgical centers (ASCs), with an estimated half of all joint replacements to be outpatient by 2026. Optimized perioperative pain management for outpatient TKA is critical to facilitate shorter length of stay and lower opioid consumption. Further, poorly managed acute pain can increase the risk of chronic pain, which may result in downstream healthcare resource utilization (HRU) and higher overall costs. Liposomal bupivacaine (LB) is a nonopioid option that can be used to prolong postoperative analgesia after TKA.

Objective: : To evaluate the real-world impact of postoperative analgesia with LB on HRU, costs, and opioid prescription refill following TKA in ASCs.

Methods: : Adults undergoing a TKA procedure between January 2019 and November 2022 at an outpatient ASC with moderate-to-high volume of LB use were retrospectively identified from IQVIA’s New Data Warehouse. Patients were divided into 2 cohorts based on LB use on the date of TKA; 1:1 propensity score matching (PSM) was used to create balanced cohorts. All-cause and pain-related HRU and costs as well as opioid use were evaluated at 30, 90, and 360 days after surgery.

Results: : After PSM, each cohort included 2307 patients. Total all-cause costs were lower for patients with LB than without LB over 30, 90, and 360 days after surgery by $247, $438, and $1368, respectively (all P< 0.01). Patients with LB also demonstrated significantly lower pain-related costs than those without LB across all follow-up periods (all P< 0.05). Patients with LB had lower HRU, with fewer all-cause physical and occupational therapy (PT/OT) visits than patients without LB at all follow-up periods (30 days: 3.0 vs 3.5; 90 days: 7.1 vs 8.1; 360 days: 10.1 vs 11.6; all P< 0.01), with similar trends observed for pain-related PT/OT visits (all P< 0.01). There were fewer opioid-treated days on average over 360 days after surgery for patients with LB than without LB (30.4 vs 35.2 days; P< 0.05).

Conclusions: : Use of LB for outpatient TKA was associated with lower all-cause and pain-specific healthcare costs, largely attributable to lower outpatient expenditure (eg, PT/OT visits) over 1 year of postsurgical follow-up. These results have important implications for enhancements to postsurgical analgesia pathways and reducing healthcare utilization and costs in patients undergoing TKA in outpatient care settings.

Sponsorship:: Pacira BioSciences, Inc.