Inpatient

Economic impact of EXPAREL vs non-EXPAREL in hip fracture inpatient surgeries1

Study Objective: Determine the economic benefit of utilizing intraoperative EXPAREL in patients with fragility intertrochanteric hip fractures in comparison to a group of patients who did not receive EXPAREL

Investigator-initiated

Key outcomes of interest were

icon cost of treatment
Cost of treatment
icon or costs
OR costs
icon cost of stay
Length of stay
icon place of discharge
Place of discharge

Results

EXPAREL resulted in a lower overall cost

The total cost for EXPAREL (~$506) was about 4 times lower than that of non-EXPAREL (~$1,829) due to cost savings (~$1,323 difference) associated with the likelihood of discharge home vs SNF.

Patients treated with EXPAREL were >4x more likely to be discharged home (15.2% vs 3.6%; P=0.001).

diagram cost savings
  • This was a retrospective observational study performed at two academic medical centers between June 2016 and December 2017
  • The study included patients with intertrochanteric hip fractures treated with a cephalomedullary implant and intraoperative EXPAREL
  • Exclusion criteria included polytrauma, preexisting dementia or delirium, open reduction, pre- or postoperative anesthetic block administration, regional anesthesia, a chronic pain diagnosis, or fixation with a dynamic hip screw
  • The final cohort included 46 EXPAREL patients and 56 non-EXPAREL patients
  • Baseline characteristics were well balanced between groups (P>0.05)
  • The control group did not receive standard bupivacaine as part of their pain management, which would have provided a more direct comparison with the unique long-acting property of EXPAREL
  • The sample size was smaller compared with other retrospective cohort studies
  • Findings are based on data from two orthopedic surgeons and their institutions, which may not be descriptive of all US practices
  • The incidence of complications that may have occurred outside the hospital was not accounted for
  • Potential confounding effects associated with miscoding or undercoding the ICD codes could not be accounted for
  • Long-term complications of EXPAREL have not yet been studied
  • No statistical analysis was performed for costs

ICD, International Classification of Diseases; LOS, length of stay; OR, operating room; SNF, skilled nursing facility.

Reference: 1. Chintalapudi N, et al. Clin Orthopedic Surg. 2022;14(2):162-168. doi:10.4055/cios21024

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Important Safety Information

Indication

EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block.

Important Safety Information

  • EXPAREL is contraindicated in obstetrical paracervical block anesthesia
  • Adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via infiltration were nausea, constipation, and vomiting; adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via nerve block were nausea, pyrexia, headache, and constipation
  • Adverse reactions with an incidence greater than or equal to 10% following EXPAREL administration via infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, vision blurred, pruritus, and tachycardia
Important Safety Information
Important Safety Information

Indication

EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.

Important Safety Information

  • EXPAREL is contraindicated in obstetrical paracervical block anesthesia
  • Adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via infiltration were nausea, constipation, and vomiting; adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via nerve block were nausea, pyrexia, headache, and constipation
  • Adverse reactions with an incidence greater than or equal to 10% following EXPAREL administration via infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, vision blurred, pruritus, and tachycardia
  • Do not admix lidocaine or other non-bupivacaine local anesthetics with EXPAREL. EXPAREL may be administered at least 20 minutes or more following local administration of lidocaine
  • EXPAREL is not recommended to be used in the following patient populations: patients <6 years old for infiltration, patients younger than 18 years old for nerve blocks, and/or pregnant patients
  • Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease

Warnings and Precautions Specific to EXPAREL

  • Avoid additional use of local anesthetics within 96 hours following administration of EXPAREL
  • EXPAREL is not recommended for the following types or routes of administration: epidural, intrathecal, regional nerve blocks other than interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and adductor canal block, or intravascular or intra-articular use
  • The potential sensory and/or motor loss with EXPAREL is temporary and varies in degree and duration depending on the site of injection and dosage administered and may last for up to 5 days, as seen in clinical trials

Warnings and Precautions for Bupivacaine-Containing Products

  • Central Nervous System (CNS) Reactions: There have been reports of adverse neurologic reactions with the use of local anesthetics. These include persistent anesthesia and paresthesia. CNS reactions are characterized by excitation and/or depression
  • Cardiovascular System Reactions: Toxic blood concentrations depress cardiac conductivity and excitability, which may lead to dysrhythmias, sometimes leading to death
  • Allergic Reactions: Allergic-type reactions (eg, anaphylaxis and angioedema) are rare and may occur as a result of hypersensitivity to the local anesthetic or to other formulation ingredients
  • Chondrolysis: There have been reports of chondrolysis (mostly in the shoulder joint) following intra-articular infusion of local anesthetics, which is an unapproved use
  • Methemoglobinemia: Cases of methemoglobinemia have been reported with local anesthetic use

Please refer to full Prescribing Information.