Abstract
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.
Keywords:
Thromboprophylaxis - decision model - cost-benefit - thrombosis - embolism
