Outpatient

Real-world impact of treatment with liposomal bupivacaine on healthcare resource utilization, opioid consumption, and cost among patients undergoing total knee arthroplasty in ambulatory surgical settings in the United States1

Study Objective: To evaluate the real-world impact of postoperative analgesia with liposomal bupivacaine (LB) on healthcare resource utilization, costs, and opioid prescription refills following outpatient TKA procedures in ASCs

This was a retrospective analysis of adults undergoing TKA between January 2019 and November 2022 at an outpatient ASC identified from the IQVIA New Data Warehouse. Patients were divided into two cohorts based on EXPAREL use on the date of TKA; 1:1 propensity score matching was used to create balanced cohorts. Propensity score matching variables included age group, geographic region, payer type, year of index date, CCI categories, chronic kidney disease, diabetes, osteoarthritis, opioid use on the index date, and all-cause total outpatient day-of-surgery medical costs. The final propensity score-matched cohort included 2,307 EXPAREL patients and 2,307 non-EXPAREL patients. Baseline characteristics were well balanced between groups (SMD <0.10), with an exception for geographic region.

Limitations: This retrospective study is subject to confounding factors that may have changed at the ASCs from 2019 to 2022. The study period overlapped with the expanded indication of EXPAREL and could not account for additional clinical and economic benefits. Claims data were collected for payment purposes and may not be representative of accurate diagnoses and treatment due to coding issues. Heterogeneity in practice patterns may not be accounted for because the study design did not assess surgeon techniques or institutional protocols that can influence pain control and costs.

Key outcomes of interest

icon postoperative opiod consumption
Total opioid use through 1 year post-TKA
icon healthcare resource utilization
Healthcare resource utilization
icon costs
Associated costs

Results1

Total healthcare costs were lower up to 1 year after surgery with EXPAREL

Lower costs of care with EXPAREL vs non-EXPAREL analgesia were seen as early as 30 days after surgery, leading up to a 14% lower cost at 1 year postsurgical follow-up ($8,404 vs $9,722; $1,318 lower).

Cost differences were driven by a decrease in physical and occupational therapy visits.

247 day09 01 700 1

Limitations: Clinical outcomes beyond claims-based measures (ie, functional recovery, patient satisfaction, opioid-related AEs) were not measured and limit understanding on the analgesic’s effectiveness at large. Findings may not be reflective of favorable pricing agreements for ASCs because the database used cannot capture variation in site-level purchasing contracts or institutional pricing structures. Additionally, the database did not include data on patient activity at physician offices, pharmacies, and hospitals.

diagram total costs

AE, adverse event; ASC, ambulatory surgical center; CCI, continuous catheter infusion; SMD, standard mean difference; TKA, total knee arthroplasty.

References: 1. Lin J, et al. J Arthroplasty. 2025:1-9 doi:10.1016/i.arth.2025.10.018

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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.