Economic Evaluation of the Drugs Used In Treating Patients with Myocardial Infarction: A Systematic Review
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
In: Fuster V, Kelly BB, editors. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global
Health. The National Academies Collection: Reports funded by National Institutes of Health. Washington (DC)2010.
Talaei M, Sarrafzadegan N, Sadeghi M, Oveisgharan S, Marshall T, Thomas GN, et al. Incidence of cardiovascular diseases in an Iranian
population: the Isfahan Cohort Study. Arch Iran Med. 2013;16(3):138-44. doi: 013163/AIM.004.
Larijani B, Fakhrzadeh H, Mohaghegh M, Pourebrahim R, Akhlaghi MR. Burden of coronary heart disease on the Iranian oil industry (1999-2000). Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq almutawassit. 2003;9(5-6):904-10.
Emamgholipour S, Sari AA, Pakdaman M, Geravandi S, Sioziou A, Katifelis H, et al. Economic Burden of Cardiovascular disease in South West of Iran. Prevalence. 2018.
Iqbal R, Jahan N, Hanif A. Epidemiology and Management Cost of Myocardial Infarction in North Punjab, Pakistan. Iranian Red Crescent medical journal. 2015;17(7):e13776. doi: 10.5812/ ircmj.13776v2.
Seo H, Yoon SJ, Yoon J, Kim D, Gong Y, Kim AR, et al. Recent trends in economic burden of acute myocardial infarction in South Korea. PLoS One. 2015;10(2):e0117446. doi: 10.1371/journal. pone.0117446.
Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a
quantitative review of 23 randomised trials. Lancet. 2003;361(9351):13-20. doi: 10.1016/S01406736(03)12113-7.
Ryan TJ, Anderson JL, Antman EM, Braniff BA, Brooks NH, Califf RM, et al. ACC/AHA guidelines for the management of patients with
acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1996;28(5):1328-428.
Tinghino B, Talso M, Friz HP, Donzelli W, Consonni S, Usai P, Beretta S, Uccellini O, Amatulli A, Laface L. GISSI-3-effects of lisinopril
and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricularfunction after acute myocardial-infarction. Europace. 2014;16(12).
Tsevat J, Duke D, Goldman L, Pfeffer MA, Lamas GA, Soukup JR, et al. Cost-effectiveness of captopril therapy after myocardial infarction.
J Am Coll Cardiol. 1995;26(4):914-9. doi: 10.1016/0735-1097(95)00284-1.
Martinez C, Ball S. COST-EFFECTIVENESS OF RAMIPRIL THERAPY FOR PATIENTS WITH CLINICAL-EVIDENCE OF HEARTFAILURE
AFTER ACUTE MYOCARDIALINFARCTION. Br J Clin Pract. 1995:26-32.
Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes:
Oxford university press; 2015.
Rezapour A, Jafari A, Mirmasoudi K, Talebianpour H. Quality Assessment of Published Articles in Iranian Journals Related to Economic Evaluation in Health Care Programs Based on Drummond’s
Checklist: A Narrative Review. Iranian journal of medical sciences. 2017;42(5):427-36.
Megiddo I, Chatterjee S, Nandi A, Laxminarayan R. Cost-effectiveness of treatment and secondary prevention of acute myocardial infarction in India: a modeling study. Global heart. 2014;9(4):391-8 e3. doi: 10.1016/j.gheart.2014.07.002.
Rama M, Miraci M, Balla I, Petrela E, Malaj L, Koleci A. Cost-Effectiveness of Thrombolytic Therapy, Compared with Anticoagulants Therapy in the Treatment of Acute Myocardial Infarction in Albania. Open access Macedonian journal of medical sciences. 2015;3(2):341-4. doi: 10.3889/ oamjms.2015.060.
Wang M, Moran AE, Liu J, Coxson PG, Heidenreich PA, Gu D, et al. Cost-effectiveness of optimal use of acute myocardial infarction treatments and impact on coronary heart disease mortality in China. Circ Cardiovasc Qual Outcomes. 2014;7(1):78-85. doi: 10.1161/ CIRCOUTCOMES.113.000674.
Marcoff L, Zhang Z, Zhang W, Ewen E, Jurkovitz C, Leguet P, et al. Cost effectiveness of enoxaparin in acute ST-segment elevation myocardial infarction: the ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction TreatmentThrombolysis In Myocardial Infarction25) study.
J Am Coll Cardiol. 2009;54(14):1271-9. doi: 10.1016/j.jacc.2009.05.060.
Scuffham PA, Tippett V. The cost-effectiveness of thrombolysis administered by paramedics. Curr Med Res Opin. 2008;24(7):2045-58. doi: 10.1185/03007990802224762.
Taylor M, Scuffham PA, Chaplin S, Papo NL. An economic evaluation of valsartan for postMI patients in the UK who are not suitable for treatment with ACE inhibitors. Value Health. 2009;12(4):459-65. doi: 10.1111/j.15244733.2008.00494.x.
Welsh RC, Sauriol L, Zhang Z, Kolm P, Weintraub WS, Theroux P. Cost-effectiveness of enoxaparin compared with unfractionated heparin in ST elevation myocardial infarction patients undergoing pharmacological reperfusion: a Canadian analysis of the Enoxaparin Treatment - Thrombolysis in Myocardial Infarction (ExTRACT-TIMI) 25 trial. Can J Cardiol. 2009;25(12):e399-405.doi: 10.1016/ s0828-282x(09)70532-x.
Araujo DV, Tura BR, Brasileiro AL, Luz Neto H, Pavao AL, Teich V. Cost-effectiveness of prehospital versus inhospital thrombolysis in acute myocardial infarction. Arq Bras Cardiol. 2008;90(2):91-8.
Choudhry NK, Patrick AR, Antman EM, Avorn J, Shrank WH. Cost effectiveness of providing full drug coverage to increase medication adherence in post-myocardial infarction Medicare beneficiaries. Circulation. 2008;117(10):1261-8.doi:10.1161/CIRCULATIONAHA.107.735605.
Kent DM, Vijan S, Hayward RA, Griffith JL, Beshansky JR, Selker HP. Tissue plasminogen activator was cost-effective compared to streptokinase in only selected patients with acute myocardial infarction. J Clin Epidemiol. 2004;57(8):843-52. doi: 10.1016/j. jclinepi.2004.01.008.
Maniadakis N, Kaitelidou D, Siskou O, Spinthouri M, Liaropoulos L, Fragoulakis B, et al. Economic evaluation of treatment strategies for patients suffering acute myocardial infarction in Greece. Hellenic J Cardiol. 2005;46(3):212-21.
Vale L, Steffens H, Donaldson C. The costs and benefits of community thrombolysis for acute myocardial infarction : a decision-analytic model. Pharmacoeconomics. 2004;22(14):943-54. doi: 10.2165/00019053-200422140-00004.
Ravangard R, Jafari A, Rahgoshai I, Zamirian M, Aghasadeghi K, Moarref A, et al. Comparison of the Cost-Effectiveness of Transesophgeal and Transthoracic Echocardiographies to Detect Cardioembolic Causes of Stroke in Non-Selected Patients. International Cardiovascular Research Journal. 2018;12(2) :43-49.
Hatam N, Dehghani M, Habibian M, Jafari A. Cost-Utility Analysis of IEV Drug Regimen Versus ESHAP Drug Regimen for the Patients With Relapsed and Refractory Hodgkin and Non-Hodgkin’s Lymphoma in Iran. Iranian journal of cancer prevention. 2015;8(5):e4061. doi: 10.17795/ijcp-4061.
Andronis L, Barton P, Bryan S. Sensitivity analysis in economic evaluation: an audit of NICE current practice and a review of its use and value in decision-making. Health Technol Assess. 2009;13(29):iii, ix-xi, 1-61. doi: 10.3310/hta13290.
Bojke L, Claxton K, Sculpher M, Palmer S. Characterizing structural uncertainty in decision analytic models: a review and application of
methods. Value Health. 2009;12(5):739-49. doi: 10.1111/j.1524-4733. 2008.00502. x.
Briggs AH, Ades AE, Price MJ. Probabilistic sensitivity analysis for decision trees with multiple branches: use of the Dirichlet distribution in a Bayesian framework. Med Decis Making. 2003;23(4):341-50. doi: 10.1177/0272989X03255922.
Briggs AH, Goeree R, Blackhouse G, O’Brien BJ. Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for gastroesophageal reflux disease. Med
Decis Making. 2002;22(4):290-308. doi: 10.1177/0272989X0202200408.
Hutubessy R, Chisholm D, Edejer TT. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost effectiveness and resource allocation :
C/E. 2003;1(1):8. doi: 10.1186/1478-7547-1-8.
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