PAIN RELIEF Exparel works, but costs significantly more than traditional options that are just as effective.

In a head-to-head comparison of Exparel and conventional bupivacaine at relieving pain after knee replacement, a new study shows Exparel is no better than the long-available generic — despite costing 25 times as much.

To determine if the drug decreased post-op pain scores or reduced opioid consumption during recovery from unilateral knee replacement, researchers at the Virtua Joint Replacement Institute in Voorhees, N.J., randomly assigned 207 patients to receive intra-articular injections of bupivacaine and morphine at the conclusion of the procedure, a periarticular injection of bupivacaine and morphine, or a periarticular injection of Exparel. Patients in each group reported similar pain scores and consumed the same amount of morphine equivalents, according to the findings.

The effectiveness of Exparel had previously been compared with placebo, but this was the first head-to-head comparison of identical intra-articular and periarticular injections administered to total knee patients. While both drugs worked well, Exparel costs $402 a dose, compared with approximately $16 for the traditional pain control methods. Reducing and managing pain after knee replacement is possible with a medication that is both affordable and effective, which could lead to significant healthcare savings, researchers say.

"In the current era of medicine, value-based care is being sought out as the defining outcome," says Rajesh Jain, MD, orthopedic surgeon at Virtua Health and lead author of the study. "Value is a combination of quality of care, including outcomes and cost."

The findings support an Outpatient Surgery Magazine special report that compared the cost-effectiveness of Exparel with straight bupivacaine. The report suggests surgical facilities might be paying too much for pain relief that falls short of the 72 hours of analgesia that Exparel is marketed to provide.

Researchers presented their findings at the recent meeting of the American Association of Hip and Knee Surgeons in Dallas, Texas, earlier this month. At the same meeting, Pacira Pharmaceuticals, the maker of Exparel, announced the results of a study that shows the drug decreases opioid use and hospital readmission rates in patients who undergo total knee replacements. The company claims the additional cost of using Exparel is offset by shorter anesthesia induction times, shorter hospital stays and lower rates of 30-day readmissions.

Daniel Cook