Cost-benefit relationship of keeping dantrolene stocks from the point of view of healthcare institutions

  • David A. Rincón-Valenzuela a. Operating Room Department, Clínica Universitaria Colombia (Clínica Colsanitas), Bogotá, Colombia. b. School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
  • Ciro Gómez-Ardila Finance and Control Department, INALDE Business School, Universidad de La Sabana, Chía, Colombia.
Keywords: Anesthesia, Malignant Hyperthermia, Dantrolene, Economics, Hospital, Economics; Pharmaceutical, Decision Making, Organizational



Malignant hyperthermia (MH) is an acute syndrome triggered by certain anesthetic medications. Dantrolene is the only specific treatment for MH crises. Without treatment, lethality may be as high as 80%. In Colombia, it is not mandatory to keep dantrolene supplies in stock.


To establish the cost-benefit ratio, from the perspective of healthcare institutions, of keeping dantrolene supplies in stock in the operating theater.


Using a decision tree, a Monte Carlo simulation was run with 10,000 scenarios to determine the median annual cost of keeping full or partial stocks (36 or 12 vials x 20 mg, respectively) of dantrolene. For the option of not keeping supplies in stock, the cost threshold was calculated where the expected value of both alternatives of the decision tree is equalized. Indifference curves were constructed for complete and partial supplies.


The median annual cost was estimated at 6.6 million Colombian pesos (COP) for full dantrolene supplies, and at COP 2.2 million for partial supplies. The median economic consequence threshold for 1 death due to the unavailability of dantrolene was estimated at COP 18.5 million for full supplies, and at COP 57.0 million for partial supplies.


If, as a result of the unavailability of dantrolene, the economic consequences of a death due to MH exceed the threshold of COP 57.0 or COP 18.5 million, the purchase of full or partial stocks, respectively, is justified.


Rosenberg H, Pollock N, Schiemann A, et al. Malignant hyperthermia: a review. Orphanet J Rare Dis 2015;10:93.

Kim D-C. Malignant hyperthermia. Korean J Anesthesiol 2012; 63:391-401.

Ording H. Incidence of malignant hyperthermia in Denmark. Anesth Analg 1985;64:700-704.

Ortiz Gómez JR. Anesthesia in malignant hyperthermia. Rev Esp Anestesiol Reanim 2008;55:165-174.

Brady JE, Sun LS, Rosenberg H, et al. Prevalence of malignant hyperthermia due to anesthesia in New York State, 2001-2005. Anesth Analg 2009;109:1162-1166.

Sumitani M, Uchida K, Yasunaga H, et al. Prevalence of malignant hyperthermia and relationship with anesthetics in Japan: data from the diagnosis procedure combination database. Anesthesiology 2011;114:84-90.

Austin KL, Denborough MA. Drug treatment of malignant hyperpyrexia. Anaesth Intensive Care 1977;5:207-213.

Krause T, Gerbershagen MU, Fiege M, et al. Dantrolene-a review of its pharmacology, therapeutic use and new developments. Anaesthesia 2004;59:364-373.

Litman RS, Smith VI, Larach MG, et al. Consensus statement of the malignant hyperthermia association of the United States on unresolved clinical questions concerning the management of patients with malignant hyperthermia. Anesth Analg 2019;128:652-659.

Denborough MA, Lovell RRH. Anaesthetic deaths in a family. Lancet 1960;276:45.

Britt BA, Kalow W. Malignant hyperthermia: a statistical review. Can Anaesth SocJ 1970;17:293-315.

Ho PT, Carvalho B, Sun EC, et al. Cost-benefit analysis of maintaining a fully stocked malignant hyperthermia cart versus an initial dantrolene treatment dose for maternity units. Anesthesiology 2018;129:249-259.

Baquero Molina N, Murillo Londoño ÁM. Propuesta para el manejo de la hipertermia maligna en la red integrada de servicios de salud. Bogotá: Secretaría Distrital de Salud; 2018.

Neira VM. Hipertermia maligna en Latinoamérica. Colombian Journal of Anesthesiology 1993;21:385-386.

Pfenninger E, Heiderich S, Klingler W. Stocks of dantrolene in anesthesia and intensive care units in Germany. Anaesthesist 2017;66:773-781.

Larach MG, Klumpner TT, Brandom BW, et al. Succinylcholine use and dantrolene availability for malignant hyperthermia treatment: database analyses and systematic review. Anesthesiology 2019;130:41-54.

Palmer S, Raftery J. Economics notes: opportunity cost. BMJ 1999;318:1551-1552.

Leung L. Health economic evaluation: a primer for healthcare professionals. Prim Health Care Open Access 2016;6: DOI:10.4172/2167-1079.1000223.

Bojke L, Manca A, Asaria M, et al. How to appropriately extrapolate costs and utilities in cost-effectiveness analysis. PharmacoEconomics 2017;35:767-776.

In J, Ahn EJ, Lee DK, et al. Incidence of malignant hyperthermia in patients undergoing general anesthesia: protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2017;96:e9115.

Strazis KP, Fox AW. Malignant hyperthermia: a review of published cases. Anesth Analg 1993;77:297-304.

Aderibigbe T, Lang BH, Rosenberg H, et al. Cost-effectiveness analysis of stocking dantrolene in ambulatory surgery centers for the treatment of malignant hyperthermia. Anesthesiology 2014;120:1333-1338.

Riazi S, Larach MG, Hu C, et al. Malignant hyperthermia in Canada: characteristics of index anesthetics in 129 malignant hyperthermia susceptible probands. Anesth Analg 2014;118: 381-387.

Edwards AW. The meaning of binomial distribution. Nature 1960;186:1074.

González J, Wiberg M, von Davier AA. A note on the Poisson’s binomial distribution in item response theory. Appl Psychol Meas 2016;40:302-310.

Glahn KPE, Ellis FR, Halsall PJ, et al. Recognizing and managing a malignant hyperthermia attack: guidelines from the European Malignant Hyperthermia Group. Br J Anaesth 2010; 105:417-420.

Kollmann-Camaiora A, Alsina E, Domínguez A, et al. Clinical protocol for the management of malignant hyperthermia. Rev Esp Anestesiol Reanim 2017;64:32-40.

Rincón-Valenzuela DA, Sessler DI. Jaramillo Mejía J, Echeverry Marín PC, Gómez Menéndez JM. Hipertermia maligna. Tratado de anestesia pediátrica Bogotá: S.C.A.R.E; 2015;1034-1071. Editorial.

Rojas JE. ¿Por fin dantroleno? Colombian Journal of Anesthesiology 2004;32:87-89.

Kim HJ, Koh WU, Choi JM, et al. Malignant hyperthermia and dantrolene sodium. Korean J Anesthesiol 2019;72:78-79.

Rosero EB, Adesanya AO, Timaran CH, et al. Trends and outcomes of malignant hyperthermia in the United States, 2000 to 2005. Anesthesiology 2009;110:89-94.

Li G, Brady JE, Rosenberg H, et al. Excess comorbidities associated with malignant hyperthermia diagnosis in pediatric hospital discharge records. Paediatr Anaesth 2011;21:958-963.

Husereau D, Drummond M, Petrou S, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Value Health 2013;16:e1-e5.

Brannon I. What is a life worth? Rochester, NY: Social Science Research Network; 2005.

Kniesner TJ, Viscusi WK, Woock C, et al. The value of a statistical life: evidence from panel data. Rev Econ Stat 2012;94:74-87.

Charris H, Oliveros H, León A, et al. Cirugía cardíaca en un paciente sospechoso de hipertermia maligna. Colombian Journal of Anesthesiology 1993;21:403-406.

Neira VM. Hipertermia maligna en Bogotá. Colombian Journal of Anesthesiology 1993;21:385-386.

How to Cite
Rincón-Valenzuela DA, Gómez-Ardila C. Cost-benefit relationship of keeping dantrolene stocks from the point of view of healthcare institutions. Colomb. J. Anesthesiol. [Internet]. 2020 Apr. 1 [cited 2024 May 30];48(2):63-70. Available from:


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How to Cite
Rincón-Valenzuela DA, Gómez-Ardila C. Cost-benefit relationship of keeping dantrolene stocks from the point of view of healthcare institutions. Colomb. J. Anesthesiol. [Internet]. 2020 Apr. 1 [cited 2024 May 30];48(2):63-70. Available from:


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