Cost-benefit Analysis of Maintaining a Fully Stocked Malignant Hyperthermia Cart versus an Initial Dantrolene Treatment Dose for Maternity Units.
Cost-benefit Analysis of Maintaining a Fully Stocked Malignant Hyperthermia Cart versus an Initial Dantrolene Treatment Dose for Maternity Units.
复制标题
维持备货充足的恶性高热推车与产科病房初始丹曲林治疗剂量的成本效益分析。
DOI：
10.1097/aln.0000000000002231
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发表时间：
2018
期刊：
影响因子：
8.8
通讯作者：
Riley,EdwardT
中科院分区：
文献类型：
--
作者：
Ho,PhiT;Carvalho,Brendan;Sun,EricC;Macario,Alex;Riley,EdwardT
背景：美国恶性高热协会建议在10分钟内给药丹曲林。获得丹曲林的一种方法是一辆装有丹曲林、其他药物和用品的恶性热疗车。然而，这可能不是成本效益的产科单位，触发剂很少使用。方法：我们对美国每个产科单位维持恶性热疗车与初始剂量为250mg的丹曲林进行了成本效益分析。我们使用决策树模型来估计挽救生命的预期数量，并将此收益与政策的预期成本进行比较。结果：我们发现，在美国的每个产科病房维持恶性热疗车，每年可使全国发病率和死亡率降低3,304,641美元，但每年将花费5,927,040美元。敏感性分析表明，我们的结果很大程度上是由于全身麻醉的发生率极低。如果美国剖宫产率保持在所有分娩的32%，那么全麻率必须大于11%才能达到成本效益。唯一具有成本效益的策略是在开始治疗时保持250毫克剂量的丹曲林。结论：在产科病房10分钟内维持一辆满载丹曲林的恶性热疗车并不符合成本效益。我们建议医院采取替代策略（例如，在产科病房开始治疗时保持少量丹曲林供应）。
Background: The Malignant Hyperthermia Association of the United States recommends that dantrolene be available for administration within 10 minutes. 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: We performed a cost-benefit analysis of maintaining a malignant hyperthermia cart vs an initial dantrolene dose of 250 mg on every maternity unit in the United States. We used a decision tree model to estimate the expected number of lives saved and compared this benefit 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 minutes of maternity units. We recommend that hospitals institute alternative strategies (eg maintain a small supply of dantrolene on the maternity unit for starting treatment).