title: [Cost-effectiveness of buccal midazolam in the treatment of prolonged convulsive seizures in the outpatient setting in Spain].
abstract: BACKGROUND
  To be able to treat prolonged epileptic crises practical, safe and effective rescue medication is needed. Today, the standard treatment in community healthcare is rectal diazepam. The introduction of a buccal solution of midazolam opens up a new perspective in their treatment.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of buccal midazolam with respect to rectal diazepam for children diagnosed with epilepsy who present prolonged convulsive seizures in the community setting in Spain.
  
  
  METHODS
  The study produces a model of its cost-effectiveness from the perspective of the Spanish National Health System (SNS), with the outcomes presented in terms of cost-quality adjusted life years. Data were collected from different sources, including estimations regarding the clinical effectiveness from a clinical trial, from a Delphi panel in Spain and from a national survey carried out on parents of children with epilepsy in order to determine the current practices.
  
  
  RESULTS
  Treatment with buccal midazolam produces a saving in costs in comparison to rectal diazepam. The amount saved by the Spanish SNS comes to 5,484 euros per patient per year. Treatment with buccal midazolam offers an improved health-related quality of life. This, together with the savings in costs, means that there is a dominance of buccal midazolam over rectal diazepam in all the settings that have been examined.
  
  
  CONCLUSIONS
  The results obtained with the model show that buccal midazolam is more cost-effective than rectal diazepam due to a reduction in the need to call out ambulances and for stays in hospital, as well as an improved health-related quality of life.
authors.forename: Miquel
authors.initials: M
authors.lastname: Raspall-Chaure
authors.affiliation: UAM. Universidad Autonoma de Madrid. Hospital Universitario La Paz, 28046 Madrid, Espana.
authors.forename: Antonio
authors.initials: A
authors.lastname: Martinez-Bermejo
authors.forename: Rocío
authors.initials: R
authors.lastname: Sanchez-Carpintero
authors.forename: M Luz
authors.initials: ML
authors.lastname: Ruiz-Falco Rojas
authors.forename: Alfonso
authors.initials: A
authors.lastname: Verdu-Perez
authors.forename: Patricia
authors.initials: P
authors.lastname: Smeyers-Dura
authors.forename: Rafael
authors.initials: R
authors.lastname: Camino-Leon
authors.forename: Francesc X
authors.initials: FX
authors.lastname: Sanmarti
authors.forename: José
authors.initials: J
authors.lastname: Santos-Borbujo
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pico
authors.forename: Oscar
authors.initials: O
authors.lastname: Blanco-Barca
authors.forename: M Antonia
authors.initials: MA
authors.lastname: Cebollero
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics; D000927:Anticonvulsants / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018849:Controlled Clinical Trials as Topic / Q000706:statistics & numerical data; D017046:Cost Savings / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D003663:Decision Trees; D003697:Delphi Technique; D003975:Diazepam / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction; D019057:Quality-Adjusted Life Years; D012996:Solutions; D013030:Spain; D013226:Status Epilepticus / Q000188:drug therapy*
chemical_list: D000927:Anticonvulsants; D012996:Solutions; D003975:Diazepam; D008874:Midazolam