Cost-effectiveness analysis of stocking dantrolene in ambulatory surgery centers for the treatment of malignant hyperthermia.
BACKGROUND
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.


METHODS
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.


RESULTS
The estimated annual number of MH 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.


CONCLUSIONS
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.
From the Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York (T.A., B.H.L.); Department of Graduate Medical Education, Saint Barnabas Medical Center, Livingston, New Jersey (H.R.); Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York (Q.C.); and Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York (G.L.). Current address: Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (T.A.).
Taiwo
T
Aderibigbe
Barbara H
BH
Lang
Henry
H
Rosenberg
Qixuan
Q
Chen
Guohua
G
Li
D000556:Ambulatory Surgical Procedures / Q000191:economics* / Q000379:methods; D000768:Anesthesia, General / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D003620:Dantrolene / Q000008:administration & dosage / Q000191:economics*; D003663:Decision Trees; D006801:Humans; D008305:Malignant Hyperthermia / Q000188:drug therapy* / Q000453:epidemiology; D013531:Surgicenters / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome
D003620:Dantrolene