Acosta P C, Trobe J D, Shuster J J, Krischer J P
Med Decis Making. 1981;1(2):125-44. doi: 10.1177/0272989X8100100204.
In the investigation of visual loss from anterior visual pathway disease, it is imperative to differentiate the infrequent compressive from the much more common noncompressive lesions. To determine how relatively low-cost, risk-free, but error-prone visual field examination (VF) and high-cost, risk-prone, but accurate CT Scan (CT) and cerebral angiography (Angio) can be cost-effectively utilized to solve this diagnostic problem, the authors have developed a decision making model for the analysis of three management strategies. The visual field examination precedes and determines the use of neuroradiologic studies in Strategy A (VF-CT-Angio), whereas it follows the neuroradiologic studies in Strategies B (CT-VF-Angio) and C (CT-Angio-VF). The visual field-determined strategy (A) proved most cost-effective, based upon an estimated 6% or lower relative prevalence of chiasmal compressive lesions, a negligible risk in delaying their diagnosis, and a sensitive method of visual field examination. At a visual field sensitivity to chiasmal defects of 84% and a specificity of 88%, Strategy A annually saves $4 million over Strategy B and $27 million over Strategy C. At lower levels of perimetric accuracy, Strategy B is the most cost-effective approach. Strategy C is never cost-effective.
在对前部视觉通路疾病导致的视力丧失进行调查时，必须区分罕见的压迫性病变和更为常见的非压迫性病变。为了确定如何以具有成本效益的方式利用相对低成本、无风险但容易出错的视野检查（VF）以及高成本、有风险但准确的CT扫描（CT）和脑血管造影（血管造影）来解决这一诊断问题，作者开发了一种决策模型，用于分析三种管理策略。在策略A（VF-CT-血管造影）中，视野检查先于并决定神经放射学检查的使用，而在策略B（CT-VF-血管造影）和策略C（CT-血管造影-VF）中，视野检查则在神经放射学检查之后进行。基于估计6%或更低的交叉压迫性病变相对患病率、延迟诊断的风险可忽略不计以及一种敏感的视野检查方法，视野检查决定的策略（A）被证明是最具成本效益的。在视野对交叉缺陷的敏感性为84%、特异性为88%的情况下，策略A每年比策略B节省400万美元，比策略C节省2700万美元。在视野检查准确性较低的情况下，策略B是最具成本效益的方法。策略C永远不具有成本效益。
