Myocardial infarction : Costs and benefits of prevention and treatments

Sammanfattning: This work focuses on economic evaluations of treatment and secondaryprevention in myocardial infarction. The purpose of the study was threefold: To present and discuss a robust method for economic evaluations of medical technologies based on individual clinical studies: to empirically apply the method to treatments and secondary prevention programs at the time of and after myocardial infarction in order thereby to increase knowledge about costs and cost effectiveness of myocardial infarction treatments: and to compare these results with those of other similar studies. The work is divided into two parts. The first part presents the problem area, the method, discusses methodological problems and compares results of the empirical studies with other studies within the area. The second part consists of four papers which present the empirical studies comprising the work. The first three papers are economic evaluations of postinfarction prophylaxis with B-blockers, intravenous thrombolysis in myocardial infarction and rehabilitation after infarction. The fourth study focuses on the health care costs of AMI.The methodological problems discusses are: the choice between differentdata sources: the validity of the cost measures: the inclusion or exclusionof indirect costs: the choice of analysis perspective: the validity of the quality adjustments of life years: and the problem of how to discount life years. The results of the empirical economic evaluations of postinfarctprophylaxis with Jl-blockers and rehabilitation after myocardial infarctionshow that both therapies are cost effective since they result in both decreased costs and improved patient health. The economic evaluation ofthrombolysis in myocardial infarction shows that in comparison withmany other treatments, it has a low cost effectiveness ratio. The comparisons with other studies in the area point out great methodological differences which make it difficult to compare results.