REAL-WORLD ASSESSMENT OF OPIOID AND HEALTH ECONOMIC OUTCOMES IN MEDICARE ADVANTAGE BENEFICIARIES UNDERGOING TOTAL SHOULDER ARTHROPLASTY
Author(s)
Jennifer Lin, PhD1, Carl V. Asche, BA, MBA, MSc, PhD2, Gabriel Wong, PharmD3, Priyanka Priyanka, MPH3;
1Pacira, senior dir, Parsippany, NJ, USA, 2University of Utah College of Pharmacy, Salt Lake City, UT, USA, 3Pacira BioScience, Brisbane, CA, USA
1Pacira, senior dir, Parsippany, NJ, USA, 2University of Utah College of Pharmacy, Salt Lake City, UT, USA, 3Pacira BioScience, Brisbane, CA, USA
OBJECTIVES: Although total shoulder arthroplasty (TSA) procedures have been increasingly performed in outpatient care settings, little is known about the impact of postsurgical analgesia on clinical and economic outcomes after TSA. This study assessed liposomal bupivacaine (LB), a long-acting local anesthetic, in relation to outcomes of total healthcare cost and opioid intake (in morphine milligram equivalents [MMEs]) over 3 months after TSA in hospital outpatient settings.
METHODS: This retrospective cohort study included patients from Optum Clinformatics® (date range, 2019-2024) who underwent outpatient TSA (CPT code: 23472). Included patients received LB or standard care options (non-LB) if they had no prior opioid exposure (ie, opioid naive) with Medicare Advantage plan, had ≥6 months continuous enrollment before/after TSA, and received TSA in hospitals with LB use. Propensity scoring was used to match LB with non-LB patients (1:1) by 12 covariates. Outcome comparison was performed using generalized linear regression modeling with gamma (cost) and Tweedie (MMEs) distribution.
RESULTS: Both LB and non-LB cohorts (3223 patients each) were well balanced (standardized mean difference, <0.1), with a mean age of 74 years and mean Quan-Charlson comorbidity index of 2.1; 31% had history of chronic pain. Compared with non-LB, LB was associated with $352 lower any-cause total episode-of-care cost at 1 month follow-up since surgery ($29,540 vs $29,892; P<0.01). There were also $720 savings with LB versus non-LB of any-cause total episode cost over 3-month follow-up since surgery ($34,002 vs $34,722 savings; P=0.04). Additionally, patients receiving LB versus non-LB consumed 24 fewer MMEs during the first week (171 vs 195 MMEs; P<0.001) and 37 fewer MMEs over 3 months (241 vs 278 MMEs; P<0.001) after surgery.
CONCLUSIONS: LB in outpatient TSA was associated with lower total episode-of-care cost and opioid intake over 3-month follow-up in opioid-naive patients, suggesting a benefit of LB use as part of postsurgical pain management
METHODS: This retrospective cohort study included patients from Optum Clinformatics® (date range, 2019-2024) who underwent outpatient TSA (CPT code: 23472). Included patients received LB or standard care options (non-LB) if they had no prior opioid exposure (ie, opioid naive) with Medicare Advantage plan, had ≥6 months continuous enrollment before/after TSA, and received TSA in hospitals with LB use. Propensity scoring was used to match LB with non-LB patients (1:1) by 12 covariates. Outcome comparison was performed using generalized linear regression modeling with gamma (cost) and Tweedie (MMEs) distribution.
RESULTS: Both LB and non-LB cohorts (3223 patients each) were well balanced (standardized mean difference, <0.1), with a mean age of 74 years and mean Quan-Charlson comorbidity index of 2.1; 31% had history of chronic pain. Compared with non-LB, LB was associated with $352 lower any-cause total episode-of-care cost at 1 month follow-up since surgery ($29,540 vs $29,892; P<0.01). There were also $720 savings with LB versus non-LB of any-cause total episode cost over 3-month follow-up since surgery ($34,002 vs $34,722 savings; P=0.04). Additionally, patients receiving LB versus non-LB consumed 24 fewer MMEs during the first week (171 vs 195 MMEs; P<0.001) and 37 fewer MMEs over 3 months (241 vs 278 MMEs; P<0.001) after surgery.
CONCLUSIONS: LB in outpatient TSA was associated with lower total episode-of-care cost and opioid intake over 3-month follow-up in opioid-naive patients, suggesting a benefit of LB use as part of postsurgical pain management
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD84
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), STA: Surgery