OBJECTIVES: To evaluate the total treatment cost and cost-effectiveness of treatments for elderly patients with acute myocardial infarction and patients for which treatment starts later, in the Greek NHS. METHODS: Data are coming from large RCTs evaluating the treatments considered. Outcomes include all major health events associated with an AMI. Trial data we extracted and used to populate a decision analytic model that computes events rates, survival and costs from AMI occurance till death. The model reports results for patients above 75 and for patients for which treatments starts at least 4 hours after symptom onset. The database of a large University Hospital was analyzed to estimate in-patient and outpatient costs associated with various events. Simulation was used to test the robustness of the results. RESULTS: For patients above 75 life time costs on alteplase, reteplase and tenecteplase were estimated, at €13.485, €13.400, and €13.824 respectively. Average survival was 1.8396, 1.8039, and 1.9325 years respectively. Tenecteplase has marginally higher cost and outcomes. Alteplase and tenecteplase dominate the second arm and the incremental-cost-per-life-year-saved of tenecteplase over alteplase is about €3600, and for that reason it should be preferred on the basis of its very cost-effective ratio. For patients at the age of 62, for whom treatment starts late the average cost and survival was €23.671, €23.304, €24.343, and 7.9172, 7.7716, and 8.2093 respectively. The incremental cost of tenecteplase was lower this time at €2.305. These results are based the point estimates and in general terms they also hold true when simulation is employed. CONCLUSIONS:. The treatments evaluated here are similar in respect of total treatment costs, so that it is difficult to distinguish between them. If anything, tenecteplase is characterized by a marginally better cost-effectiveness ratio.