Abstracts

RATIONALE: Given the expense of newer AED formulations and emphasis on cost containment, we analyzed our clinical practice experience with diazepam rectal gel (DRG) in mentally-retarded multiply-handicapped (MRMH)epilepsy patients from an institutionalized setting to determine direct cost savings. METHODS: Direct cost associated with DRG use at a urban-based developmental center was retrospectively assessed. A mean of 22 months (range 19-25 mos.)before and after DRG use was compared. Twenty-four (37.5%) of 64 MRMH patients had epilepsy. Four men and 2 women (25%) had at least 1 episode of acute repetitive seizures (ARS) or prolonged seizure/status (PSS) on a mean of 2 AEDs/patient. ARS were more frequent (20.8%) than PSS (8.3%). Four (16.7%) patients with epilepsy required DRG with an average dose of 17.5 mg per event. Transport occurred if treatment failed. Direct costs per annum based on 1999 US dollars for ambulance transport, facilities fees, medication, and testing were based upon representative regional charges of $1142.25/ED visit. The average wholesale price of $156 for a DiastatTM twin pack was used. Time cost and indirect costs were not included. RESULTS: An average of 43.25 seizures/year occurred before, and 54.57 seizures/year followed DRG treatment. Of the four patients who received DRG, it was administered 41 times with approximately 5 administrations per patient per year required. No significant or unexpected adverse events from DRG were seen. A total of 7.64 ER transports/year before, and 2.73 ER transports/year occurred after DRG was used. Direct cost savings based upon ER visitation was $5608.45/year/institution. Additional estimated cost savings based on 16.36 DRG successful administrations/year yielded an additional potential savings of $18,698.63/year. The expense of a single unit dose of DiastatTM used 19.09 times/year was $1489.02/year. Total direct cost savings were estimated to be $22,818.06/year. CONCLUSIONS: Beyond the obvious clinical benefit from rapid treatment, institutionalized epilepsy patients with ARS or PSS demonstrate a safe and effective response to DRG that results in a considerable direct cost savings.