Transversus abdominis plane block with liposomal bupivacaine compared to oral opioids alone for acute postoperative pain after laparoscopic hysterectomy for early endometrial cancer: a cost-effectiveness analysis

Abstract

Background: To determine the cost-effectiveness of transversus abdominis plane block with liposomal bupivacaine (TAP) compared to oral opioids alone for acute postoperative pain after laparoscopic hysterectomy for early endometrial cancer.

Methods: A cost-effectiveness analysis using a decision tree structure with a 30.5 day time-horizon was used to calculate incremental cost-effectiveness ratio (ICER) values per quality-adjusted life-year (QALY). Base-case costs, probabilities, and QALY values were identified from recently published all-payer national database studies, 2017 Medicare fee-schedules, randomized trials, institutional case series, or assumed, when published values were not available. One-way, two-way and multiple probabilistic sensitivity analyses were performed.

Results: The TAP strategy dominated the oral opioid-only strategy, with decreased costs and increased effectiveness. Specifically, the TAP strategy saved $235.90 under the base-case assumptions. Threshold analyses demonstrated that if the relative same-day discharge probability was ≥ 12% higher in the TAP group, then TAP was cost-saving over oral opioids-alone. Similarly, TAP was cost-saving whenever the costs saved by same-day discharge compared to admission were ≥ $1115.22. Cost-effectiveness of the TAP strategy was highly robust of a variety of sensitivity analyses.

Conclusions: TAP with liposomal bupivacaine was robustly cost-effective at conventional willingness-to-pay thresholds. Further, TAP was cost-saving compared to opioids-only when the same-day discharge rate among TAP users was greater than among opioid-only users.

Keywords: Analgesia; Bupivacaine; Endometrial cancer; Pain; Transversus abdominis plane block.

Conflict of interest statement

Ethics approval and consent to participate

Institutional review board approval is not required for cost-effectiveness analyses using existing, published data.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

Tornado diagram for one-way sensitivity analyses of cost estimates

Fig. 2

Tornado diagram for one-way sensitivity analyses of probability estimates

Fig. 3

Two-way sensitivity analysis for TAP versus oral opioid-only strategies. Legend: Blue area is when the TAP strategy is cost-saving and red area is when oral opioid-only strategy is cost-saving

Fig. 4

Cost-effectiveness acceptability curves for TAP versus no-TAP strategies from probabilistic sensitivity analyses