Newly Published Free
Perioperative Medicine  |   April 2018
Cost-benefit Analysis of Maintaining a Fully Stocked Malignant Hyperthermia Cart versus an Initial Dantrolene Treatment Dose for Maternity Units
Author Notes
  • From the Department of Anesthesiology, Baylor College of Medicine, Houston, Texas (P.T.H.)
  • Department of Anesthesiology, Stanford University School of Medicine, Stanford, California (B.C., E.C.S., A.M., E.T.R.).
  • Submitted for publication January 6, 2017. Accepted for publication March 23, 2018.
    Submitted for publication January 6, 2017. Accepted for publication March 23, 2018.×
  • Research Support: Supported by the Foundation for Anesthesia Education and Research’s (Schaumburg, Illinois) 2015 Medical Student Anesthesia Research Fellowship program (to Dr. Ho) and funding from the National Institute on Drug Abuse (Bethesda, Maryland; K08DA042314), consulting fees unrelated to this work from Egalet, Inc. (Wayne, Pennsylvania), and the Mission Lisa Foundation, (Tampa, Florida) (to Dr. Sun).
    Research Support: Supported by the Foundation for Anesthesia Education and Research’s (Schaumburg, Illinois) 2015 Medical Student Anesthesia Research Fellowship program (to Dr. Ho) and funding from the National Institute on Drug Abuse (Bethesda, Maryland; K08DA042314), consulting fees unrelated to this work from Egalet, Inc. (Wayne, Pennsylvania), and the Mission Lisa Foundation, (Tampa, Florida) (to Dr. Sun).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Riley: Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305. edriley@stanford.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Neuromuscular Diseases and Drugs / Patient Safety / Pharmacology
Perioperative Medicine   |   April 2018
Cost-benefit Analysis of Maintaining a Fully Stocked Malignant Hyperthermia Cart versus an Initial Dantrolene Treatment Dose for Maternity Units
Anesthesiology Newly Published on April 18, 2018. doi:10.1097/ALN.0000000000002231
Anesthesiology Newly Published on April 18, 2018. doi:10.1097/ALN.0000000000002231
Abstract

Background: The Malignant Hyperthermia Association of the United States recommends that dantrolene be available for administration within 10 min. One approach to dantrolene availability is a malignant hyperthermia cart, stocked with dantrolene, other drugs, and supplies. However, this may not be of cost benefit for maternity units, where triggering agents are rarely used.

Methods: The authors performed a cost-benefit analysis of maintaining a malignant hyperthermia cart versus a malignant hyperthermia cart readily available within the hospital versus an initial dantrolene dose of 250 mg, on every maternity unit in the United States. A decision-tree model was used to estimate the expected number of lives saved, and this benefit was compared against the expected costs of the policy.

Results: We found that maintaining a malignant hyperthermia cart in every maternity unit in the United States would reduce morbidity and mortality costs by $3,304,641 per year nationally but would cost $5,927,040 annually. Sensitivity analyses showed that our results were largely driven by the extremely low incidence of general anesthesia. If cesarean delivery rates in the United States remained at 32% of all births, the general anesthetic rate would have to be greater than 11% to achieve cost benefit. The only cost-effective strategy is to keep a 250-mg dose of dantrolene on the unit for starting therapy.

Conclusions: It is not of cost benefit to maintain a fully stocked malignant hyperthermia cart with a full supply of dantrolene within 10 min of maternity units. We recommend that hospitals institute alternative strategies (e.g., maintain a small supply of dantrolene on the maternity unit for starting treatment).