Neurelis apology

 

Lexidrug tells me the price is $439.12 for each dose, or $2,195.60 for a 5 pack. Fortunately, the shelf life is 32-36 months. Given that most of my patients will never actually use a rescue medication, that is a hefty price.

Concentrate (diazePAM Oral) 5 mg/mL (per mL): $5.00

Cheap Diazepam Intensol (5 mg/mL) has been utilized extensively as a rescue medication for seizures, generally given buccally. I have not yet seen evidence for the superiority of Valtoco vs Diazepam Intensol.

Midazolam 10 mg/2 ml (per ml)  $0.75 - $3.86

Cheap midazolam has been used extensively as an intranasal or buccal rescue medication for seizures.

Nayzilam per 5 mg $400.15

From Nickels, Katherine C. “Less Effective and More Expensive: Is It Time to Move on From Rectal Diazepam?.” Epilepsy currents vol. 18,1 (2018): 27-28. doi:10.5698/1535-7597.18.1.27: According to this study, the most cost-effective therapy was buccal midazolam, with absolute cost effectiveness of $7.93/SS. Nasal midazolam, nasal lorazepam, and intramuscular midazolam had similar costs, ranging from $13.37/SS to $15.54/SS. The only outlier was rectal diazepam, costing $435.16/SS at the time of their study. Rectal diazepam remained the outlier when incremental effectiveness and willingness to pay were analyzed. The authors determined that, based on efficacy, rectal diazepam would not be cost-effective unless the cost were $6 or less. The current cost of rectal diazepam is approximately $326.

Valtoco and Nayzilam are the current outliers.

I am currently freely prescribing Valtoco and Nayzilam, but I hold my nose when I do so.