Berwick D M, Weinstein M C
Med Care. 1985 Jul;23(7):881-93.
Evaluations of diagnostic tests have focused primarily on their value in clinical decisions. Patients may attach value to 1) information that has little or no medical significance, and 2) information (medical or nonmedical) that has no bearing on decisions to be made by the doctor or the patient. Ultrasound in pregnancy, which provides a great deal of information to both doctor and patient, was chosen as the example with which to explore these hypotheses. Sixty-two women with current or recent normal pregnancies were given a structured interview to elicit their willingness to pay for ultrasound information. Among these women, 26% of the value attached to the test related to information having no decisional significance, and 37% of the value related to information of use to the patient, but not the doctor. Overall, 44% of the value of the test, from the patients' point of view, pertained to uses outside the realm of medical decisions. On the average, interviewees alleged that they would pay +706 for the information contained in an ultrasound test in an uncomplicated pregnancy. Decision analyses and cost-effectiveness analyses that take note only of the medical, decisional uses of test information may overlook a high proportion of the value patients attach to the information.
对诊断测试的评估主要集中在其在临床决策中的价值。患者可能重视以下两类信息：1）几乎没有或没有医学意义的信息；2）与医生或患者要做出的决策无关的信息（医学或非医学信息）。以孕期超声检查为例来探讨这些假设，因为它能为医生和患者提供大量信息。对62名目前或近期妊娠正常的女性进行了结构化访谈，以了解她们为超声检查信息付费的意愿。在这些女性中，对该检查赋予的价值里，26%与无决策意义的信息相关，37%与对患者而非医生有用的信息相关。总体而言，从患者角度看，该检查44%的价值与医疗决策范围之外的用途有关。平均而言，受访者称他们愿意为简单妊娠中超声检查所包含的信息支付706美元。仅考虑测试信息的医学、决策用途的决策分析和成本效益分析可能会忽略患者赋予该信息的很大一部分价值。
