• Miquel Raspall-Chaure, Antonio Martinez-Bermejo, Rocío Sanchez-Carpintero, M Luz Ruiz-Falco Rojas, Alfonso Verdu-Perez, Patricia Smeyers-Dura, Rafael Camino-Leon, Francesc X Sanmarti, José Santos-Borbujo, Gustavo Pico, Oscar Blanco-Barca, and M Antonia Cebollero.
• UAM. Universidad Autonoma de Madrid. Hospital Universitario La Paz, 28046 Madrid, Espana.
• Rev Neurol. 2014 Jun 1; 58 (11): 481-6.

IntroductionTo 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.AimsTo 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.Materials And MethodsThe 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.ResultsTreatment 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.ConclusionsThe 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.

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