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The estimated effectiveness of non\u2010intravenous benzodiazepines (non\u2010IV BZDs) ranges from approximately 70% to 90% and the estimated effectiveness of non\u2010benzodiazepine antiseizure medications (non\u2010BZD ASMs) ranges from approximately 50% to 80%. This study aimed to quantify the clinical and economic burden of decisional uncertainty in the treatment of SE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a decision analysis that evaluates how decisional uncertainty on treatment choices for SE impacts hospital admissions, intensive care unit (ICU) admissions, and costs in the United States. We evaluated treatment effectiveness based on the available literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Use of a non\u2010IV BZD with high estimated effectiveness, like intranasal midazolam, rather than one with low estimated effectiveness, like rectal diazepam, would result in a median (p<jats:sub>25<\/jats:sub>\u2010p<jats:sub>75<\/jats:sub>) reduction in hospital admissions from 6 (3.9\u20108.8) to 1.1 (0.7\u20101.8) per 100 cases and associated cost reductions of $638 ($289\u2010$1064) per pediatric patient and $1107 ($972\u2010$1281) per adult patient. For BZD\u2010resistant SE, use of a non\u2010BZD ASM with high estimated effectiveness, like phenobarbital, rather than one with low estimated effectiveness, like phenytoin\/fosphenytoin, would result in a reduction in ICU admissions from 9.1 (7.3\u201011.2) to 3.9 (2.6\u20105.5) per 100 cases and associated cost reduction of $1261 ($445\u2010$2223) per pediatric patient and $319 ($\u201093\u2010$806) per adult patient. Sensitivity analyses showed that relatively minor improvements in effectiveness may lead to substantial reductions in downstream hospital admissions, ICU admissions, and costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Decreasing decisional uncertainty and using the most effective treatments for SE may substantially decrease hospital admissions, ICU admissions, and costs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.16646","type":"journal-article","created":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T09:12:47Z","timestamp":1600765967000},"page":"2150-2162","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The burden of decisional uncertainty in the treatment of status epilepticus"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4313-002X","authenticated-orcid":false,"given":"Iv\u00e1n","family":"S\u00e1nchez Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children\u2019s Hospital Harvard Medical School Boston MA USA"},{"name":"Department of Child Neurology Hospital Sant Joan de D\u00e9u Universidad de Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9175-9458","authenticated-orcid":false,"given":"Marina","family":"Ga\u00ednza\u2010Lein","sequence":"additional","affiliation":[{"name":"Division of Epilepsy and Clinical Neurophysiology Department of Neurology Boston Children\u2019s Hospital Harvard Medical School Boston MA USA"},{"name":"Instituto de Pediatr\u00eda Facultad de Medicina Universidad Austral de Chile Valdivia Chile"},{"name":"Servicio de Neuropsiquiatr\u00eda Infantil. 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