Real-World Data on Liposomal Bupivacaine and Inpatient Hospital Costs After Colorectal Surgery.
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INTRODUCTION: This study compared costs of care among colorectal surgery patients who received liposomal bupivacaine versus those who did not (control) from a health institution perspective. MATERIAL AND METHODS: This pharmacoeconomic evaluation was conducted among adults undergoing open or minimally invasive colorectal resection at an academic medical center from May 2016 to February 2018. Healthcare resource utilization was derived from the electronic health record. Total cost of care (2018 USD) was analyzed using a generalized linear model adjusted for American Society of Anesthesiologists score, enhanced recovery after surgery management, open surgery, opioid use before surgery, height, cancer, and age. The primary analysis used public costs. A sensitivity analysis used internal costs from the hospital to maximize internal validity. RESULTS: Of 486 included patients, 286 (59%) received liposomal bupivacaine. Total cost of care using public costs included perioperative local anesthetics (meanstandard deviation [SD]: $39274 liposomal bupivacaine versus $813 control), analgesics within 48h after surgery (meanSD: $13299 liposomal bupivacaine versus $117127 control), postoperative ileus management (meanSD: $551 liposomal bupivacaine versus $65284 control), and hospital length of stay (meanSD: $44593576 liposomal bupivacaine versus $77697082 control). Liposomal bupivacaine was associated with an adjusted absolute difference in total cost of care of -$1435 (95% confidence interval -$2401 to -$470; P=0.004) using public costs and -$1345 (95% confidence interval -$2215 to -$476; P=0.002) using internal costs. CONCLUSIONS: Use of liposomal bupivacaine in colorectal surgery was associated with a significant reduction in total cost of care that was predominately driven by reduced costs for hospital stay and postoperative ileus management despite higher medication costs.
