J Pediatr Epilepsy 2016; 05(04): 186-190
DOI: 10.1055/s-0036-1584912
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Impact on ED Utilization and Associated Costs of Abortive Seizure Medications Using an Accountable Care Organization Database

Sunjay Nunley1, Daniel M. Cohen2, Justin Cole3, Anup D. Patel1
  • 1Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio, United States
  • 2Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
  • 3Department of Pharmacy, Nationwide Children's Hospital, Columbus, Ohio, United States
Further Information

Publication History

22 July 2015

17 March 2016

Publication Date:
29 June 2016 (eFirst)


Intranasal (IN) midazolam and per rectum (PR) diazepam abort seizures in the outpatient setting. IN midazolam is easier to use, has fewer side effects, and is more cost-effective than PR diazepam. The aim of this study is to determine if outpatient IN midazolam impacts emergency department (ED) utilization and health care costs compared with PR diazepam by utilizing a claims database. We retrospectively reviewed 5 years of data for 929 patients extracted from a claims database of an accountable care organization, Partners for Kids, whose population covers central and southeastern Ohio. Data elements consisted of demographics, ED visits, health care costs, and number of prescriptions. We found that using IN midazolam was not associated with increased ED utilization or increased health care costs. PR diazepam was associated with higher prescription costs. These findings support previous studies and show that both IN midazolam and PR diazepam are viable treatment options for patients at risk for prolonged seizures, but that IN midazolam is more cost-effective.