Does the evidence support Exparel’s high price tag?
- Approved for use in 2011, Exparel is a local anesthetic used to treat postoperative pain, for example in hip and knee surgery.
- US health systems spend upwards of $270M annually on Exparel.
- Despite limited evidence of superiority over older anesthetics, Exparel is priced 10x higher than comparators.
A health system in the Northwest was alarmed to discover a 7% annual increase in spend for anesthetics used for postoperative analgesia, as well as wide variation in preference among physicians.
Lumere’s review of 100+ studies did not find strong evidence that Exparel led to better outcomes than the less costly pain relief analgesics Bupivacaine or Ropivacaine in total knee/hip arthroplasty and most gastrointestinal surgeries.
Specifically the evidence showed:
- Additional studies are needed to establish Exparel’s superiority in reducing pain
- Exparel showed inconsistent results in reducing opioid use compared to less costly alternatives
- Exparel use may not be warranted due to lack of demonstrated impact on length of stay
Analysis of the system’s spend and utilization data showed that procedures in which Exparel lacked differentiation accounted for the majority of utilization. To facilitate change, Lumere provided physician-level analysis and evidence to drive physician discussions.
annual savings in Exparel spend
reduction in spend through appropriate usage
impact on outcomes
Restricting Exparel utilization in most orthopedic and gastrointestinal surgeries will yield a projected $980,000 in annual savings — 85% off a base spend of $1.2M — without negatively impacting patient outcomes.