Eiseman B, Jones R, McClatchey M, Borlase B
World J Surg. 1989 May-Jun;13(3):272-6. doi: 10.1007/BF01659033.
Proper diagnostic test selection and logical sequencing can minimize cost without compromising care. This study analyzes the logic for sequencing tests either in series (one after another) or in parallel (simultaneously). A model is created using 2 diagnostic tests for 2 diseases. Tests are assumed to have perfect performance characteristics. Factors involved in cost-effective test sequencing include cost of each test, test performance characteristics, per diem hospital charge, and the clinician's prior probability of the suspected diagnosis based on history, physical examination, and previous laboratory data. At a given point of clinical suspicion, cost-effective sequencing strategy should shift. In general, a cheap test can effectively be used in parallel even at low diagnostic probabilities; an expensive test should, in general, be used in series only when there is a high prior probability of diagnosis. High per diem hospitalization costs--such as for a patient in the intensive care unit--favor in parallel testing. Clinical acumen and suspicion of diagnosis (prior probability) primarily direct cost-effective diagnostic test sequencing. Decision analysis of diagnostic test sequencing represents a technique for making cost-effective decisions for sequencing and, thereby, minimizing costs while achieving optimal patient care.
正确选择诊断测试并进行合理排序可以在不影响医疗质量的前提下降低成本。本研究分析了串联（依次进行）或并联（同时进行）测试排序的逻辑。使用针对两种疾病的两项诊断测试建立了一个模型。假设测试具有完美的性能特征。具有成本效益的测试排序所涉及的因素包括每项测试的成本、测试性能特征、每日住院费用，以及临床医生根据病史、体格检查和先前实验室数据对疑似诊断的先验概率。在临床怀疑的特定阶段，具有成本效益的排序策略应该改变。一般来说，即使在诊断概率较低时，便宜的测试也可以有效地并联使用；一般而言，昂贵的测试通常仅在诊断先验概率较高时才串联使用。每日住院费用高昂（如重症监护病房患者）有利于并联测试。临床敏锐度和对诊断的怀疑（先验概率）主要指导具有成本效益的诊断测试排序。诊断测试排序的决策分析是一种用于做出具有成本效益的排序决策的技术，从而在实现最佳患者护理的同时将成本降至最低。
