Economic Evaluation of the Drugs Used In Treating Patients with Myocardial Infarction: A Systematic Review

Aziz Rezapour, Marziye Hadian, Mohammad Ghasemi, Sajad Vahedi, Abdosaleh Jafari


Introduction: Myocardial infarctions (MI), as one of the outcomes of cardiovascular
diseases, are responsible for 20% of deaths, so that every 30 seconds, one person suffers
from MI. Various drugs are used to treat myocardial infarction, and we need to have precise
information of the cost-effectiveness of these drugs. The aim of this study was to examine
economic evaluation of the drugs used for treatment of patients with MI.
Methods: In the present systematic review study, published articles related to economic
evaluation of the drugs used for treatment of patients with MI within the time interval
between 2000 and 2017 were searched, using electronic databases such as Tufts Medical
Center Cost-Effectiveness Analysis Registry ,Cochrane library, NHS Economic Evaluations
Database Medline, PubMed, Google scholar, web of science using the following keywords:
Cost- effectiveness* OR cost- utility* OR economic evaluation * AND (myocardial infarction *) AND (angiotensin- converting enzyme inhibitor (lisinopril) OR thrombolytic agents
(streptokinase, anistreplase or anisoylated plasminogen streptokinase activator complex OR beta blockers (metoprolol, propranolol, atenolol, acebutolol, bisoprolol). Due to heterogeneity in the outcome, we were not able to use meta-analysis. Methodological quality of the structuree of tarticles was examined by Drummond’s standard checklist.
Results: Based on the inclusion criteria, the search of databases resulted in 12 articles that
fully covered economic evaluation of the drugs used in treating patients with MI. The results
of the present study indicated that a streptokinase and t-PA drug for treatment of patients
with myocardial infarction was cost-effective. The results showed that most of the studies
clearly stated the time horizon of the study and included direct medical costs in their analysis. In addition, the majority of the studies were used the Markov model. The quality-adjusted life years (QALYs) were the main outcome used for measuring the effectiveness.
Conclusion: The results of the present study showed that a thrombolytic agent for treatment
of patients with myocardial infarction was cost-effective. The results were relatively varied due to the differences in time horizon and variables used in the models such as efficacy and drug prices. Furthermore, these studies were designed and conducted in high-income countries;  thus, the application of these results in low- and middle-income countries will be limited.
Keywords: Economic evaluation, Systematic review, Myocardial Infarction, Drummond’s

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