DOI: 10.6084/m9.figshare.29169595.v1
title: Effects of Liposomal Bupivacaine (LB) and provider experience with LB on service utilization, clinical outcomes, and Medicare expenditures among fee-for-service (FFS) beneficiaries

description: To assess the effects of Liposomal Bupivacaine (LB) and provider LB use rate for 6 months after discharge on service utilization, clinical outcomes, and Medicare expenditures among Fee for Service (FFS) beneficiaries who have undergone hospital outpatient department (HOPD) procedures. 100% Medicare Research Identifiable Files data from 2019 to 2023 was utilized. Medicare FFS beneficiaries with the top 100 HOPD surgical procedures where LB was utilized were included in the study and divided into two cohorts: received LB (treatment) and did not receive LB (comparison) during the surgical procedure. An Inverse Probability Treatment Weighting Propensity Score model was estimated to balance treatment and control groups. We estimated Emergency Department (ED) admission, Short Term Acute Care Hospitals (STACH) admission, mortality, Opioid Use Disorder (OUD) and Opioid prescription fill events, and spending metrics. LB use contributed to significant reductions in ED admission (9%; 23.28% vs. 25.69%), STACH admission (8%; 11.61% vs. 12.65%), mortality (39%; 0.67% vs. 1.1%) and opioid prescription fills (6%; 1.8 vs. 1.92) within 180-days post-discharge. Total Medicare expenditures (180-day episode) were $245 lower for the LB user ($9,645 vs. $9,891). For each 10-percentage point increase in provider LB use-rate, the likelihood of ED admission, STACH admission, mortality, and OUD decreased by 0.1, 0.15, 0.01 and 0.02 percentage points, respectively. Total Medicare expenditures (180-day episode) were reduced by $258 for every one percentage point increase in LB use-rate. Use of LB and provider LB use rate are associated with improved patient clinical, service utilization, and expenditure outcomes. Liposomal bupivacaine (LB) represents a significant advancement in postoperative pain management, with studies demonstrating its ability to reduce opioid consumption and improve recovery outcomes. Previous studies have found that increased provider LB use rate is associated with reduced ED admissions, STACH admissions, and Opioid prescription fill events among Medicare beneficiaries undergoing HOPD procedures. However, research is lacking to estimate the effect of LB use on mortality, OUD, and total Medicare spending. Using an IPTW propensity score model and associated outcome regressions we find that both LB use and provider LB use rate had a statistically significant impact on reducing total Medicare expenditures per patient per 180-day episode ($245 and $258 respectively, p &lt; 0.01), with the most significant reduction in spending for Inpatient and SNF care settings. We also find that increased LB use leads to lower service utilization and improved clinical outcomes. The results of the study have important implications for CMS policies to improve quality and reduce health costs for the targeted patient population using LB for post-surgical pain management. Since provider LB use rate can provide better post-surgical outcomes for Medicare patients while reducing overall total Medicare costs, CMS policies could support increased provider LB use by facilitating provider access to LB to have a meaningful impact on reducing opioid consumption and decreasing Medicare expenditures.