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

Abstract

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.

Keywords

per rectum diazepam - emergency department - intranasal midazolam

• References

• 1 Del Pizzo J, Callahan JM. Intranasal medications in pediatric emergency medicine. Pediatr Emerg Care 2014; 30 (7) 496-501 , quiz 502–504
• 2 Thakker A, Shanbag P. A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures. J Neurol 2013; 260 (2) 470-474
• 3 Fişgin T, Gurer Y, Teziç T , et al. Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. J Child Neurol 2002; 17 (2) 123-126
• 4 Bhattacharyya M, Kalra V, Gulati S. Intranasal midazolam vs rectal diazepam in acute childhood seizures. Pediatr Neurol 2006; 34 (5) 355-359
• 5 Holsti M, Sill BL, Firth SD, Filloux FM, Joyce SM, Furnival RA. Prehospital intranasal midazolam for the treatment of pediatric seizures. Pediatr Emerg Care 2007; 23 (3) 148-153
• 6 Holsti M, Dudley N, Schunk J , et al. Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med 2010; 164 (8) 747-753
• 7 Kelleher KJ, Cooper J, Deans K , et al. Cost saving and quality of care in a pediatric accountable care organization. Pediatrics 2015; 135 (3) e582-e589
• 8 Patel AD. Variables associated with emergency department and/or unplanned hospital utilization for children with epilepsy. Epilepsy Behav 2014; 31: 172-175
• 9 Wier LM, Yu H, Owens PL, Washington R. Overview of Children in the Emergency Department, 2010. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb157.pdf . Published June 2013
• 10 Reid AY, St Germaine-Smith C, Liu M , et al. Development and validation of a case definition for epilepsy for use with administrative health data. Epilepsy Res 2012; 102 (3) 173-179
• 11 Helmers SL, Duh MS, Guérin A , et al. Clinical outcomes, quality of life, and costs associated with implantation of vagus nerve stimulation therapy in pediatric patients with drug-resistant epilepsy. Eur J Paediatr Neurol 2012; 16 (5) 449-458
• 12 Manjunath R, Paradis PE, Parisé H , et al. Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization. Neurology 2012; 79 (18) 1908-1916
• 13 Cramer JA, Wang ZJ, Chang E , et al. Healthcare utilization and costs in children with stable and uncontrolled epilepsy. Epilepsy Behav 2014; 32: 135-141
• 14 Bautista RE, Glen ET, Wludyka PS, Shetty NK. Factors associated with utilization of healthcare resources among epilepsy patients. Epilepsy Res 2008; 79 (2–3) 120-129
• 15 Lee DC, Gladwell D, Hatswell AJ , et al. A comparison of the cost-effectiveness of treatment of prolonged acute convulsive epileptic seizures in children across Europe. Health Econ Rev 2014; 4: 6 DOI: 10.1186/s13561-014-0006-6.
• 16 Ashrafi MR, Khosroshahi N, Karimi P , et al. Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children. Eur J Paediatr Neurol 2010; 14 (5) 434-438
• 17 Raspall-Chaure M, Martinez-Bermejo A, Sanchez-Carpintero R , et al. Cost-effectiveness of buccal midazolam in the treatment of prolonged convulsive seizures in the outpatient setting in Spain [in Spanish]. Rev Neurol 2014; 58 (11) 481-486