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Maintaining a Malignant Hyperthermia Treatment Cart Within Labor and Delivery Suites is Not Cost-Effective
Abstract Number: T-01
Abstract Type: Original Research
Introduction: Dantrolene is known to be an effective treatment for Malignant Hyperthermia (MH), and the Malignant Hyperthermia Association of the United States (MHAUS) recommends dantrolene be administered within 10 minutes of the decision to treat for MH. However, MH-triggering agents are rarely used in obstetric suites. The goal of this analysis was to assess the economics of maintaining a MH cart in labor and delivery instead of relying on MH carts available in other areas of the hospital.
Methods: The predicted incidence of MH in women managed in an obstetric suite was computed by estimating the incidence of general anesthesia and MH from published literature and institutional data. The costs of maintaining a MH cart on labor and delivery were estimated by combining drugs, equipment, supplies and labor costs (pharmacist and nurse time for MH cart maintenance and preparedness training). A decision tree model with Monte Carlo simulations was used to evaluate the cost-effectiveness from society’s perspective of having a MH cart on labor and delivery, facilitating treatment immediately within 10 minutes compared to using a MH cart from another area in the hospital with treatment within 40 minutes from decision to treat.
Results: Assuming a national cesarean delivery rate of 32.2%, with 5.6% of these receiving general anesthesia, the MH incidence in peripartum patients was estimated to be 1 in 170,968. The estimated annual cost of having dantrolene immediately available in all obstetric suites in the U.S. is $8,708,060, or $2,962 per suite. Having a MH cart immediately available in the obstetric suite compared to using a MH cart from another area in the hospital (e.g. the main operating room suite), would collectively save an additional 0.06 lives per year in the US; an incremental cost-effectiveness ratio of $150,646,468 per life saved. Applying the most favorable assumptions for having a MH cart in labor and delivery resulted in a cost-effectiveness ratio of $20,461,059 per life saved, which is significantly greater than what is commonly accepted as cost-effective.
Conclusion: The Joint Commission has set standards and elements of performance, which suggest all labor and delivery suites maintain their own MH carts. However, this is not cost-effective due to how few MH-triggering general anesthetics are given to parturients combined with the low incidence of MH. MHAUS recommendation for immediate dantrolene availability in the obstetric setting is not a cost-effective strategy. Findings suggest that having a MH cart close enough to a labor and delivery suite to initiate treatment within 40 minutes is a more appropriate policy.
1. Malignant Hyperthermia Association of the United States http://www.mhaus.org/faqs/dantrolene
2. The Joint Commission Comprehensive Accreditation Manual for Hospitals (2013).
3. Rev Econ Stat. (2012). 94 74–87