The role of age in cost-benefit analysis of thromboprophylaxis

Socioeconomic studies about deep-vein thrombosis prophylaxis with low-molecular-weight heparins have shown that general prophylaxis in patients at risk is economically justified. However, the question arises whether the guidelines for thromboprophylaxis developed hitherto provide a fair balance between the medical as well as the socio-economic standpoint and the need of the individual patient. Thromboprophylaxis has to be performed according to acknowledged professional standards under the restraints of cost-effectiveness, whereas the patient is only interested in receiving the best treatment available. Guidelines for thromboprophylaxis are based on the allocation of risk factors, one of those, a higher age of the patient. Most guidelines mention a threshold of 40 years, only in cases where additional risks prevail, thromboprophylaxis in younger patients is recommended. Because some trials suggest that the thromboembolic risk in young patients has been underestimated so far, a computer model was developed to determine the age-dependent cost-benefit ratio for thromboprophylaxis. The results with different sets of input data show that providing thromboprophylaxis to younger patients is also cost-effective, suggesting to reconsider the existing medical guidelines.