Midazolam vs diazepam in prolonged seizures in children: A pharmacoeconomic approach.
OBJECTIVE
A previous European cost-utility study reported that use of buccal midazolam in the community setting for the treatment of prolonged seizures (ie, seizures lasting ≥5 minutes) in children was associated with an overall €12 507 399 reduction in annual costs charged to the Italian national health service compared with rectal diazepam. We re-evaluated these findings by applying a more conservative approach.


METHODS
The Italian Delphi panel reconvened to apply a more conservative assessment of available reports. A decision-tree model was used, allowing for different treatment pathways depending on whether or not a caregiver administers treatment, an ambulance is required for transport of the child to hospital, and an inpatient stay is required. Direct medical costs were derived from Italian healthcare system data. Estimates of the annual number of prolonged tonic-clonic seizures expected in the country were based on studies which assessed seizure duration using video-EEG recordings and medical records.


RESULTS
Although drug acquisition costs were greater for buccal midazolam than for rectal diazepam, the acquisition cost difference was outweighed by larger cost savings resulting mostly from a reduction in hospital admissions. Assuming that 1.2% of tonic and/or clonic seizures occurring in children and adolescents over a 12-month period are prolonged, the annual nationwide reduction in costs from preferring buccal midazolam to rectal diazepam was estimated at €3 577 587.9.


CONCLUSIONS
In this more conservative revised analysis, the high cost of buccal midazolam is still counteracted by greater cost savings compared with rectal diazepam, but cost reduction was less than previously estimated.
['Beghi|E|E|http://orcid.org/0000-0003-2542-0469', 'Capovilla|G|G|', 'Franzoni|E|E|', 'Minicucci|F|F|', 'Romeo|A|A|', 'Verrotti|A|A|', 'Vigevano|F|F|', 'Perucca|E|E|']
D000278:Administration, Buccal D000285:Administration, Rectal D000293:Adolescent D000927:Anticonvulsants D002648:Child D003663:Decision Trees D003975:Diazepam D017850:Economics, Pharmaceutical D005260:Female D006801:Humans D007223:Infant D008297:Male D008874:Midazolam D012640:Seizures
midazolam diazepam children cost