Thrombolytic therapy reduces early mortality, preserves left ventricular 
function and improves long term prognosis of acute myocardial infarction. 
However it is relatively expensive and increasing use will have considerable 
financial consequences. With competing demand for health resources, information 
on economic evaluation of this revolutionary therapeutic modality is much 
needed. Economic evaluation of thrombolytic therapy of acute myocardial 
infarction entails the assessment of all resources consumed (costs) directly and 
indirectly in relation to the administration of thrombolytic drugs, versus the 
beneficial effects (outcome) on health preservation of the patients. To save 1 
year of life, the costs of thrombolytic therapy using intravenous streptokinase, 
alteplase (recombinant tissue plasminogen activator; rt-PA) or anistreplase 
(anisoylated plasminogen streptokinase activator complex) under standard 
restricted indication criteria, vary from 1000 pounds British sterling to 1700 
pounds British sterling in the UK, SEK3090 to 9660 in Scandinavia and $US35 000 
to 800 000 in the US, depending on time delay in starting treatment after pain 
onset, size of infarct, thrombolytic agents used, study methodology, lists of 
clinical events considered in cost counting and the discount rate. Cost-utility 
analyses revealed that the costs of thrombolytic treatment are similar to those 
of many other treatments for cardiac or other diseases, but methods for 
evaluating quality of life and utility require further refinement and 
validation. Economic assessments confirm that thrombolytic treatment of the 
elderly ( greater than 70 years) is as cost-effective as treatment of younger 
patients and that both early and late thrombolytic therapy (given 6 to 12 hours 
after infarction) are beneficial and cost-effective. There are major logistical 
problems with prehospital thrombolysis, which despite great initial enthusiasm, 
is unlikely to be cost-effective in saving lives unless savings in time are 
greater than 1 hour. Cost-effectiveness/utility value of one drug determined 
from one study cannot be directly compared with that found in other studies 
using different drugs. More direct prospective comparative trials will be needed 
in respect of relative benefits and costs with different agents and adjunctive 
therapies.