“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 HyperthermiaMalignant 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.
Research MethodsA 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.
ResultsThe 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.
ConclusionThe 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 HyperthermiaMalignant 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.
About the Malignant Hyperthermia Association of the United States (MHAUS)MHAUS was founded by families who lost their children to MH or could not find information about MH. In 1981 they found each other - and a doctor performing MH testing – and agreed “to make current information about MH available to all who need it!”
Since 1981 MHAUS has asked fostered the following: the World Health Organization (WHO) to add MH to its list of recognized diseases and disorders. In 1983 the first MHAUS healthcare professional and patient teaching conference. In 1992 the FDA ordered pharmaceutical companies that manufacture succinylcholine to change the package insert to indicate that the drug should not be used routinely in children. In 1995 the MH 24-hour Hotline was formalized and MHAUS merged with the North American MH Registry, which had been established in 1987. In 1997 the MHAUS website was formed along with the Neuroleptic Malignant Information Service of MHAUS. In 1998 the MH ID Tag program was created. In 2000 the MH Procedure Manual was created for ambulatory surgery centers, hospitals, and office based surgery suites. In 2001 the MH Patient Liaison Committee was formed. In 2003 a new mutation in ryanodine receptor gene was discovered and appears to be causal for MH. More at: www.mhaus.org.
Today MHAUS provides information and resources to medical and lay communities through conferences, educational materials, ID tags, 24-hour MH Hotline, MHAUS website, and with the help of MH Groups.
The mission of Malignant Hyperthermia Association of the United States is to promote optimum care and scientific understanding of MH and related disorders. MH episodes can happen at any time and MHAUS will always be ready to provide assistance when you need it. But the best way protect your family and patients is to be prepared before it’s too late. Get Involved with MHAUS today to find out what you can do to make a difference.
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