Example: comparison of rectal diazepam versus buccal midazolam

Here, we compare the cost-effectiveness of rectal diazepam versus buccal midazolam as an example of how to use our apps:

1.Select the relevant app, in this case the pediatric comparison for non-intravenous benzodiazepines:

https://ivansanchez.shinyapps.io/nonIVBZD_Pediatric/

2.Assuming that buccal midazolam has a mean (standard deviation) effectiveness of 0.73 (0.065) and a likeliest cost of 5.79 USA dollars with a minimum of 2.18 USA dollars and a maximum of 9.39 USA dollars [Sanchez Fernandez I., Gainza-Lein M., Loddenkemper T. Nonintravenous rescue medications for pediatric status epilepticus: A cost-effectiveness analysis. Epilepsia, 58(8):1349–1359, 2017], modify the inputs so that one of the options contains the data for rectal diazepam and the other one contains the data for buccal midazolam. In this case, buccal midazolam is the low-effectiveness non-intravenous rescue medication, because the effectiveness of rectal diazepam is slightly higher.

3.After one minute of data processing, the results show that using buccal midazolam (rather than rectal diazepam) would result in a median (p25-p75) of 1.2 increase in admissions per 100 cases (from 1.3 decrease to 3.4 increase), although this would translate into a median (p25-p75) reduction in costs of 302 USA dollars (reduction of 732 USA dollars to increase in 108 USA dollars) per patient.

In summary, the downstream clinical and economic consequences of using rectal diazepam or buccal midazolam are very similar.