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 (TAP) with liposomal bupivacaine has been studied as an effective method of reducing the need for post-operative 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 (ICER) per quality adjusted life year (QALY). Base case costs, QALY 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 post-operative period. Finally, we performed one-way, two-way, and probabilistic sensitivity analyses. Results: The liposomal bupivacaine TAP block was a dominant strategy yielding a $456.75 decrease in cost and an 0.1 increase in QALYs relative to opioids alone. In one-way sensitivity analysis of cost ICER values were most sensitive to variations in the amount saved by SDD and the cost of bupivacaine. In probabilistic sensitivity analyses, TAP strategy was cost-effective at a willingness-to-pay threshold of $50,000/QALY in 94.5% of iterations and at a willingness-to-pay threshold of $100,000/QALY in 97.1% of iterations. Conclusions: The use of liposomal bupivacaine TAP block resulted in cost savings and improved QALYs in base case analyses and was cost-effective at conventional willingness to pay thresholds in the majority of iterations in probabilistic sensitivity analyses.