Cost and Value

EXPAREL is available in 133 mg (10 mL) dose for $227.63 and 266 mg (20 mL) dose for $376.12. The 133 mg (10 mL) and 266 mg (20 mL) doses of EXPAREL are available in cartons of 4 and 10 vials. For more information please visit How to order EXPAREL.

Information below helps review the value of EXPAREL in a multimodal pain management protocol that can lead to fewer opioids,* better pain control, and shorter LOS. These, in turn, can lead to fewer patient complications and reduced hospital costs per patient.

Unilateral, Single-Level Transforaminal Lumbar Interbody Fusion:
Medical center in Massachusetts

Study Methods

  • 37 adult patients undergoing unilateral, single-level TLIF with EXPAREL compared with a historic control for the same procedure (N=74)
  • Retrospective, observational study matched 1:1 to controls
  • Surgical and treatment protocol was the same for both groups. In the EXPAREL group, EXPAREL was infiltrated at the conclusion of surgery in addition to the standard, nonliposomal local anesthetic received by the control group
  • Cost was analyzed from the hospital perspective and savings per procedure were determined by the mean total costs for patients in both groups
  • Means and standard deviations were analyzed for all presurgical and postsurgical outcomes

Safety Outcomes

  • The overall rate of complications was identical in both groups (8.1%)
  • No adverse events were attributed to the use of EXPAREL

Clinical and Economic Outcomes

Patients who received ERP with EXPAREL to manage pain after surgery had

  • Significantly

    better pain control

    reported in the
    first 24 hours*

    • 0 to 12 hours: 15.0 vs 45.6 (P=0.003)
    • 12 to 24 hours: 37.6 vs 48.4 (P=0.05)

  • 34%

    fewer opioids

    used at 12 to
    24 hours†‡

    • 12 to 24 hours: 16.0 vs 24.1 (P=0.04)

  • 1.2 Days

    shorter LOS

    • 3.1 vs 4.3 days (P<0.001)

  • $590

    lower mean total
    per-patient cost

    • $14,816 vs $15,406
 

ERP ALONE (n=37)

  • Standard postsurgical treatment protocol
    • Acetaminophen
    • Oral and intravenous narcotics
      • Oxycodone or hydromorphone
    • Muscle relaxants
      • Cyclobenzaprine, diazepam, or tizanidine
  • Received an intraoperative injection of lidocaine or bupivacaine hydrochloride

ERP WITH EXPAREL (n=37)

  • Identical ERP as in ERP-alone group
  • Local infiltration into the surgical site with EXPAREL expanded with saline and bupivacaine hydrochloride

*Pain was self-reported by patients using the visual analog scale. Scores recorded over the first 3 days were divided into 12-hour intervals and used to calculate the area under the curve.

†Opioid consumption was measured using intravenous morphine milligram equivalent.

‡The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials.

TLIF, transforaminal lumbar interbody fusion; ERP, enhanced recovery protocol; LOS, length of stay.

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