ESTIMATED COST OF BUPIVACAINE LIPOSOMAL INJECTABLE SUSPENSION IN MEDICARE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY USING PREMIER CHARGEMASTER DATA

The Comprehensive Care for Joint Replacement (CJR) program provides incentives for hospitals to improve the quality of THA while reducing costs to Medicare. Although BLIS may reduce hospital length of stay (LOS) and increase home discharge, concerns have been raised about its cost. The goal of this study was to compare the charges and costs of BLIS to total hospital charges and costs for THA Medicare patients. The Premier Database was used to identify the five hospitals with the highest use of BLIS for Medicare patients undergoing primary THA (ICD-9 procedure 81.51) between 2013 and 2015. Total mean hospital charges (using chargemaster data) and costs (estimated by Premier with proprietary charge to cost methodology) for THA overall and BLIS were compared across hospitals. Results were compared to patients from the same hospitals who did not receive BLIS. The five study hospitals each performed 187 to 465 primary THA procedures in Medicare patients with BLIS (total 1,534) and 353 to 585 (total 2,295 patients) without BLIS. Total hospital charges with BLIS were $35,424 to $73,251 (mean $54,831), while total estimated hospital costs were $12,746 to $19,181 (mean $16,268). Charges for BLIS represented 1.1% to 1.9% (mean 1.6%) of total hospital charges for THA, while costs for BLIS were 1.5% to 2.1% (mean 1.9%) of total hospital costs for THA. The highest average wholesale price for BLIS for this period was $300, while the costs estimated by Premier varied from $198 to $334 (mean $304). Total hospital costs were $552 lower when receiving BLIS vs. controls. An analysis of Premier hospital chargemaster data suggested that the cost of BLIS represented less than 2% of total hospital costs for Medicare patients undergoing THA. Use of BLIS for THA was associated with a reduction in total hospital costs of 3%.