Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair

Background: Transversus abdominis plane block with liposomal bupivacaine has been studied as an effective method of reducing the need for postoperative opioids and increasing same-day discharge rates. However, less is known about the cost-effectiveness of this strategy relative to opioids alone for...

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Main Authors: Alexander L. Colonna, Brandon K. Bellows, Toby M. Enniss, Jason B. Young, Marta McCrum, Jade M. Nunez, Raminder Nirula, Richard E. Nelson
Format: Article
Language:English
Published: Elsevier 2020-04-01
Series:Surgery Open Science
Online Access:http://www.sciencedirect.com/science/article/pii/S2589845020300038
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spelling doaj-69c75b14570844ddb37f309ed668c0672020-11-25T02:51:53ZengElsevierSurgery Open Science2589-84502020-04-01227580Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repairAlexander L. Colonna0Brandon K. Bellows1Toby M. Enniss2Jason B. Young3Marta McCrum4Jade M. Nunez5Raminder Nirula6Richard E. Nelson7University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT 84132; Corresponding author.University of Utah, School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT 84132University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT 84132University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT 84132University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT 84132University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT 84132University of Utah, School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132Background: Transversus abdominis plane block with liposomal bupivacaine has been studied as an effective method of reducing the need for postoperative opioids and increasing same-day discharge rates. However, less is known about the cost-effectiveness of this strategy relative to opioids alone for hernia repair. We performed an economic evaluation of these strategies using a computer simulation model. Methods: A decision tree was constructed to determine cost-effectiveness as measured by incremental cost-effectiveness ratios per quality-adjusted life-year. Base-case costs, quality-adjusted life-year values, and probabilities were derived from published studies and Medicare fee schedules. For input parameters for which we could not find values in the published literature, we used expert opinion. A 1-month time horizon was selected to focus on the immediate postoperative period. Finally, we performed 1-way, 2-way, and probabilistic sensitivity analyses. Results: The liposomal bupivacaine transversus abdominis plane block was a dominant strategy yielding a $456.75 decrease in cost and an 0.1 increase in quality-adjusted life-years relative to opioids alone. In 1-way sensitivity analysis of cost incremental cost-effectiveness ratio, values were most sensitive to variations in the amount saved by same-day discharge and the cost of bupivacaine. In probabilistic sensitivity analyses, transversus abdominis plane strategy was cost-effective at a willingness-to-pay threshold of $50,000/quality-adjusted life-year in 94.5% of iterations and at a willingness-to-pay threshold of $100,000/quality-adjusted life-year in 97.1% of iterations. Conclusion: The use of liposomal bupivacaine transversus abdominis plane block resulted in cost savings and improved quality-adjusted life-years in base-case analyses and was cost-effective at conventional willingness-to-pay thresholds in the majority of iterations in probabilistic sensitivity analyses.http://www.sciencedirect.com/science/article/pii/S2589845020300038
collection DOAJ
language English
format Article
sources DOAJ
author Alexander L. Colonna
Brandon K. Bellows
Toby M. Enniss
Jason B. Young
Marta McCrum
Jade M. Nunez
Raminder Nirula
Richard E. Nelson
spellingShingle Alexander L. Colonna
Brandon K. Bellows
Toby M. Enniss
Jason B. Young
Marta McCrum
Jade M. Nunez
Raminder Nirula
Richard E. Nelson
Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair
Surgery Open Science
author_facet Alexander L. Colonna
Brandon K. Bellows
Toby M. Enniss
Jason B. Young
Marta McCrum
Jade M. Nunez
Raminder Nirula
Richard E. Nelson
author_sort Alexander L. Colonna
title Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair
title_short Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair
title_full Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair
title_fullStr Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair
title_full_unstemmed Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair
title_sort reducing the pain: a cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair
publisher Elsevier
series Surgery Open Science
issn 2589-8450
publishDate 2020-04-01
description Background: Transversus abdominis plane block with liposomal bupivacaine has been studied as an effective method of reducing the need for postoperative opioids and increasing same-day discharge rates. However, less is known about the cost-effectiveness of this strategy relative to opioids alone for hernia repair. We performed an economic evaluation of these strategies using a computer simulation model. Methods: A decision tree was constructed to determine cost-effectiveness as measured by incremental cost-effectiveness ratios per quality-adjusted life-year. Base-case costs, quality-adjusted life-year values, and probabilities were derived from published studies and Medicare fee schedules. For input parameters for which we could not find values in the published literature, we used expert opinion. A 1-month time horizon was selected to focus on the immediate postoperative period. Finally, we performed 1-way, 2-way, and probabilistic sensitivity analyses. Results: The liposomal bupivacaine transversus abdominis plane block was a dominant strategy yielding a $456.75 decrease in cost and an 0.1 increase in quality-adjusted life-years relative to opioids alone. In 1-way sensitivity analysis of cost incremental cost-effectiveness ratio, values were most sensitive to variations in the amount saved by same-day discharge and the cost of bupivacaine. In probabilistic sensitivity analyses, transversus abdominis plane strategy was cost-effective at a willingness-to-pay threshold of $50,000/quality-adjusted life-year in 94.5% of iterations and at a willingness-to-pay threshold of $100,000/quality-adjusted life-year in 97.1% of iterations. Conclusion: The use of liposomal bupivacaine transversus abdominis plane block resulted in cost savings and improved quality-adjusted life-years in base-case analyses and was cost-effective at conventional willingness-to-pay thresholds in the majority of iterations in probabilistic sensitivity analyses.
url http://www.sciencedirect.com/science/article/pii/S2589845020300038
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