Cost-benefit analysis--a prerequisite of a rational pharmacotherapy in cardiovascular diseases. Timely thrombolysis in the acute myocardial infarction.

The worldwide increase in the expenses of the National Health Services compels the legislation of some countries to take economizing regulatory measures. In Germany the existent and planned activities are an essential part of the German Structural Health Act of 1993. In the last years methods have been developed to estimate the cost-benefit relationship of special therapeutic interventions giving the physician an aid to avoid the application of those of low cost-efficiency. The cost-effectiveness and the cost-utility analyses are the recently most usual ones. The timely thrombolysis of the acute myocardial infarction is presented under the viewpoint of the economical drug use in cardiovascular disease. Investigations to evaluate the cost-effectiveness of streptokinase and the newer thrombolytics anistreplase and alteplase are carried out in some European countries and in the USA. Parameters of efficacy are the amelioration of cardiac functions, the shortening of the rehospitalization duration, and the extension of the survival time. The use of a thrombolytic within 4 to 6 hours after the onset of the first signs is recommended and economically justified especially in anterior myocardial infarction and also in patients aged 75 years and above. Streptokinase is designated by a low cost-effectiveness ratio. The successful thrombolysis does not result in a continous deterioration of the quality of life in the patients. In this review no attempt was made to extrapolate the findings to the recent situation because of possible national pecularities with regard to the morbidity of and the therapeutic procedures in the acute myocardial infarction and because of the changes in the cost structure and currency parity which occurred in the meantime.