OBJECTIVES: To estimate the economic impact of the use of tenecteplase versus streptokinase in patients with acute myocardial infarction (AMI). METHODS: A decision tree cost-effectiveness (CE) model assessed the treatment related cost for tenecteplase and streptokinase related to two mayor disease branches: with or without acute reperfusion therapy. In the reperfusion arm, terminal nodes included none or one or more complications; those without therapy could only survive or die. Complications comprised death, reinfarction, cardiac failure, cerebral infarction, minor and mayor bleedings and intracranial hemorrhage. Published results of head to head clinical trials or indirect comparisons efficacy inputs populated the model. Treatment algorithm was obtained from the local governmental guide. Public institutional direct medical costs (2014 purchases and price tabulators) where retrieved to adopt the national health system perspective. Governmental databases and 2014 purchases provided the epidemiology inputs. A five year forecast estimated the budget impact of the use of tenecteplase versus streptokinase. RESULTS: