Trobe J D, Krischer J P
Surv Ophthalmol. 1983 Nov-Dec;28(3):189-93. doi: 10.1016/0039-6257(83)90096-6.
Cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA) are accounting techniques that have been applied to medical decision-making. These techniques are applied here to two alternative diagnostic strategies in the work-up of patients with "unexplained visual loss." The first uses the results of visual field examination to decide if patients should have a CT scan ("visual field strategy"), the second bypasses visual fields and orders a CT scan on all patients ("CT strategy"). The analysis reveals that the visual field strategy is cost-effective only if perimetrists are able to identify hemianopic field defects in more than 80% of cases. It is doubtful that perimetrists are presently as accurate as that. These conclusions must be considered tentative since the epidemiologic data that support them are often weak. Another drawback in applying such an analysis to medical problem-solving is that costs may not accurately reflect patient valuations and choices. Nevertheless, in forcing a more comprehensive consideration of the effects of medical decisions, CEA/CBA is likely to promote increased cost-consciousness and epidemiologic research.
成本效益分析（CEA）和成本效益分析（CBA）是已应用于医疗决策的会计技术。这些技术在此应用于对“不明原因视力丧失”患者进行检查的两种替代诊断策略。第一种使用视野检查结果来决定患者是否应进行CT扫描（“视野策略”），第二种绕过视野检查，对所有患者都进行CT扫描（“CT策略”）。分析表明，只有当视野检查者能够在超过80%的病例中识别出偏盲视野缺损时，视野策略才具有成本效益。目前视野检查者是否能达到如此高的准确性值得怀疑。由于支持这些结论的流行病学数据往往很薄弱，所以这些结论必须被视为初步的。将这种分析应用于医疗问题解决的另一个缺点是，成本可能无法准确反映患者的价值评估和选择。然而，在促使对医疗决策的影响进行更全面的考虑方面，CEA/CBA可能会促进成本意识的提高和流行病学研究。
