Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain.
Epilepsia. 2017 Aug;58(8):1349-1359. doi: 10.1111/epi.13812. Epub 2017 Jun 16.
To quantify the cost-effectiveness of rescue medications for pediatric status epilepticus: rectal diazepam, nasal midazolam, buccal midazolam, intramuscular midazolam, and nasal lorazepam.
Decision analysis model populated with effectiveness data from the literature and cost data from publicly available market prices. The primary outcome was cost per seizure stopped ($/SS). One-way sensitivity analyses and second-order Monte Carlo simulations evaluated the robustness of the results across wide variations of the input parameters.
The most cost-effective rescue medication was buccal midazolam (incremental cost-effectiveness ratio ([ICER]: $13.16/SS) followed by nasal midazolam (ICER: $38.19/SS). Nasal lorazepam (ICER: -$3.8/SS), intramuscular midazolam (ICER: -$64/SS), and rectal diazepam (ICER: -$2,246.21/SS) are never more cost-effective than the other options at any willingness to pay. One-way sensitivity analysis showed the following: (1) at its current effectiveness, rectal diazepam would become the most cost-effective option only if its cost was $6 or less, and (2) at its current cost, rectal diazepam would become the most cost-effective option only if effectiveness was higher than 0.89 (and only with very high willingness to pay of $2,859/SS to $31,447/SS). Second-order Monte Carlo simulations showed the following: (1) nasal midazolam and intramuscular midazolam were the more effective options; (2) the more cost-effective option was buccal midazolam for a willingness to pay from $14/SS to $41/SS and nasal midazolam for a willingness to pay above $41/SS; (3) cost-effectiveness overlapped for buccal midazolam, nasal lorazepam, intramuscular midazolam, and nasal midazolam; and (4) rectal diazepam was not cost-effective at any willingness to pay, and this conclusion remained extremely robust to wide variations of the input parameters.
For pediatric status epilepticus, buccal midazolam and nasal midazolam are the most cost-effective nonintravenous rescue medications in the United States. Rectal diazepam is not a cost-effective alternative, and this conclusion remains extremely robust to wide variations of the input parameters.
量化儿科癫痫持续状态的抢救药物的成本效益：直肠地西泮、鼻内咪达唑仑、颊部咪达唑仑、肌肉内咪达唑仑和鼻内劳拉西泮。
使用文献中的有效性数据和公共市场价格的成本数据填充决策分析模型。主要结果是每停止一次癫痫发作的成本（/SS）。单向敏感性分析和二阶蒙特卡罗模拟评估了在输入参数广泛变化下结果的稳健性。
最具成本效益的抢救药物是颊部咪达唑仑（增量成本效益比[ICER]：$13.16/SS），其次是鼻内咪达唑仑（ICER：$38.19/SS）。鼻内劳拉西泮（ICER：-$3.8/SS）、肌肉内咪达唑仑（ICER：-$64/SS）和直肠地西泮（ICER：-$2,246.21/SS）在任何支付意愿下都不如其他选择更具成本效益。单向敏感性分析表明：（1）在其目前的有效性下，只有在其成本为 6 美元或以下时，直肠地西泮才会成为最具成本效益的选择，（2）在其目前的成本下，只有在有效性高于 0.89（并且只有在非常高的支付意愿为 2859 美元/SS 至 31447 美元/SS 时）时，直肠地西泮才会成为最具成本效益的选择。二阶蒙特卡罗模拟表明：（1）鼻内咪达唑仑和肌肉内咪达唑仑是更有效的选择；（2）在支付意愿为 14 美元/SS 至 41 美元/SS 时，更具成本效益的选择是颊部咪达唑仑，而在支付意愿高于 41 美元/SS 时，更具成本效益的选择是鼻内咪达唑仑；（3）颊部咪达唑仑、鼻内劳拉西泮、肌肉内咪达唑仑和鼻内咪达唑仑的成本效益重叠；（4）在任何支付意愿下，直肠地西泮都没有成本效益，而且这个结论在输入参数广泛变化的情况下仍然非常稳健。
对于儿科癫痫持续状态，在美国，颊部咪达唑仑和鼻内咪达唑仑是最具成本效益的非静脉内抢救药物。直肠地西泮不是一种具有成本效益的替代药物，而且这个结论在输入参数广泛变化的情况下仍然非常稳健。
