MH experts say storing dantrolene would save 33 lives per year at an incremental cost effectiveness ratio of nearly $200,000 (in 2010 dollars) per life saved, indicating that storing dantrolene at ambulatory surgical centers is very cost effective say, Malignant Hyperthermia Experts: Taiwo Aderibigbe, BS; Barbara H. Lang, BS; Henry Rosenberg, MD; Guohua Li, MD, PhD, Columbia University, New York who authored the article "Cost-Effectiveness Analysis of Stocking Dantrolene in Ambulatory Surgery Centers" that was recently published in the latest official journal of the American Society of Anesthesiologists, Anesthesiology.
"Nowadays most of anesthesia care takes place outside of hospitals. Anesthesia safety in ambulatory surgery centers is understudied and remains a serious concern. Our study indicates that requiring ambulatory surgery centers to stockpile Dantrolene as recommended by Malignant Hyperthermia Association of the United States (MHAUS) is a cost-effective measure for treating malignant hyperthermia -- an infrequent but potentially fatal complication. It will save lives and money," say Guohau Li, MD, PhD.
About Dantrolene Sodium for Injection and Malignant Hyperthermia
Malignant hyperthermia (MH) is a rare hypermetabolic syndrome of the skeletal muscle and a potentially fatal complication of general anesthesia. Dantrolene is currently the only specific treatment for MH. The Malignant Hyperthermia Association of the United States has issued guidelines recommending that 36 vials (20 mg per vial) of dantrolene remain in stock at every surgery center. However, the cost of stocking dantrolene in ambulatory surgery centers has been a concern. The purpose of this analysis is to assess the cost-effectiveness of stocking dantrolene in ambulatory surgery centers as recommended by the Malignant Hyperthermia Association of the United States.
A decision tree model was used to compare treatment with dantrolene to a supportive care-only strategy. Model assumptions include the incidence of MH, MH case fatality with dantrolene treatment and with supportive care-only. Sensitivity analyses were performed to assess the robustness of the estimated cost-effectiveness.
The estimated annual number of Malignant Hyperthermia events in ambulatory surgery centers in the United States was 47. The incremental effectiveness of dantrolene compared with supportive care was 33 more lives saved per year. The incremental cost-effectiveness ratio was $196,320 (in 2010 dollars) per life saved compared with a supportive care strategy. Sensitivity analysis showed that the results were robust for the plausible range of all variables and assumptions tested.
The results of this analysis suggest that stocking dantrolene for the treatment of MH in ambulatory surgery centers as recommended by the Malignant Hyperthermia Association of the United States is cost-effective when compared with the estimated values of statistical life used by U.S. regulatory agencies.
What is Malignant Hyperthermia
Malignant Hyperthermia (MH) is inherited genetic disorder found in an estimated 1 out of 2,000 people and triggered by certain anesthetics and/or the drug succinylcholine and most often experienced in individuals undergoing routine surgery but in rare cases MH can happen without anesthesia. The disorder is due to abnormally increased levels of cell calcium in the skeletal muscle. Symptoms include body temperature of up to 107 degrees, muscle rigidity, system-wide organ failure, and possible death.
There is mounting evidence that some patients will also develop MH with exercise and/or on exposure to hot environments. Without proper and prompt treatment with dantrolene sodium, mortality is extremely high.
The above story is based on materials provided by Malignant Hyperthermia Association of the United States (MHAUS). Note: Materials may be edited for content and length.
- Taiwo Aderibigbe, Barbara H. Lang, Henry Rosenberg, Qixuan Chen, Guohua Li. Cost-effectiveness Analysis of Stocking Dantrolene in Ambulatory Surgery Centers for the Treatment of Malignant Hyperthermia. Anesthesiology, 2014; 120 (6): 1333 DOI: 10.1097/ALN.0000000000000257
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