Cost/benefit analysis of treatment and prevention of myocardial infarction.

The benefits resulting from introduction of coronary care units, mobile coronary care units, and a screening and intervention program to decrease the incidence of myocardial infarction (MI) are reduced to a common basis by modeling the effects of the three strategies as applied to a cohort of 10-years-olds. Published data on MI are used with a semi-Markov model of death from MI and other causes to estimate program effects on long-term survival, and cost/benefit ratios are compared for the three programs with both costs and benefits discounted over the lifetime of the cohort. Some problems of selecting a discount rate for comparing programs that incur costs and accrue benefits at widely separated times are discussed.