OBJECTIVES: Despite the use of anti-epileptics, approximately 20-30 % of epileptic patients in Spain experience recurrent convulsive seizures, which require rescue medication and, sometimes, hospitalisation. Current standard first-line treatment of prolonged, acute, convulsive seizures (PACS) in the community setting comprises rectal diazepam (RD). Buccolam (licensed oromucosal midazolam) is the only oral paediatric formulation approved for the treatment of PACS in children (3 months to <18 years). We assessed the cost effectiveness of Buccolam compared to RD in the community setting in Spain. METHODS: A decision-tree model was developed to capture quality-of-life and cost implications of PACS. We assessed the treatment pathway when a child has a seizure in the community including whether or not carers administer treatment; an ambulance is required; patients are taken to hospital and require an inpatient stay. The associated cost and health-related quality of life (HRQL) impacts were calculated. Data were obtained from many sources including clinical-effectiveness estimates from McIntyre et al. 2005, a Delphi panel and a survey of parents to ascertain current practice. Costs were taken from published sources. Sensitivity analyses were conducted on both sets of data. RESULTS: Over one year, Buccolam showed a cost reduction of €4,994 per patient compared to RD and HRQL improvement of 0.0075 QALYs. The price of Buccolam would need to be more than €463/patient/year to not be cost saving. Buccolam remained dominant across a range of scenario analyses. Reduction in hospitalisations was the primary reason for overall cost savings (67% from reduced ward costs, 10% from reduced ICU costs). Ambulance and emergency costs were also significantly reduced (23% of total savings). CONCLUSIONS: Treatment with Buccolam is cost saving compared to rectal diazepam through a reduction in hospitalisations and ambulance call-outs.