IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy.
Azienda Ospedaliera Carlo Poma, Mantova, Italy.
Acta Neurol Scand. 2018 Jan;137(1):24-28. doi: 10.1111/ane.12814. Epub 2017 Sep 6.
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.
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.
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.
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.
先前的一项欧洲成本效益研究报告称，与直肠用地西泮相比，在社区环境中使用颊用咪达唑仑治疗儿童持续时间较长（即持续时间≥5 分钟）的癫痫发作可使意大利国家卫生服务机构每年的费用减少 1250.7399 万欧元。我们通过采用更保守的方法重新评估了这些发现。
意大利德尔菲小组重新召集会议，对现有报告采用更保守的评估方法。使用决策树模型，允许根据护理人员是否进行治疗、是否需要救护车将儿童送往医院以及是否需要住院治疗，采取不同的治疗途径。直接医疗成本来自意大利医疗保健系统的数据。预计全国每年出现的持续强直阵挛性癫痫发作次数的估计数基于使用视频脑电图记录和病历评估癫痫发作持续时间的研究。
尽管颊用咪达唑仑的药物购置成本高于直肠用地西泮，但购置成本差异被主要来自住院人数减少的更大成本节约所抵消。假设在 12 个月期间，儿童和青少年发生的强直和/或阵挛性癫痫发作中有 1.2%是持续的，那么从使用颊用咪达唑仑代替直肠用地西泮中，全国每年的成本节约估计为 357.7587 万欧元。
在这项更为保守的修订分析中，尽管颊用咪达唑仑的成本较高，但与直肠用地西泮相比，仍能获得更大的成本节约，但成本节约低于之前的估计。
