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Related Experiment Videos

Cost-benefit analysis in screening. Unexplained visual loss.

J D Trobe, J P Krischer

    Survey of Ophthalmology
    |November 1, 1983
    PubMed
    Summary
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    Cost-effectiveness analysis (CEA) for unexplained visual loss shows the visual field strategy is only cost-effective if visual field defects are identified over 80% of the time. Current diagnostic accuracy likely falls short of this threshold.

    Area of Science:

    • Medical Decision Making
    • Health Economics
    • Ophthalmology

    Background:

    • Cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA) are established accounting techniques applied to medical decision-making.
    • Unexplained visual loss presents a diagnostic challenge requiring evaluation of different patient management strategies.

    Purpose of the Study:

    • To compare the cost-effectiveness of two diagnostic strategies for patients with unexplained visual loss.
    • To evaluate a "visual field strategy" versus a direct "CT strategy" for diagnosing visual loss.

    Main Methods:

    • Comparative analysis of two diagnostic pathways: "visual field strategy" (using visual field results to guide CT scans) and "CT strategy" (ordering CT scans for all patients).
    • Application of cost-effectiveness and cost-benefit analysis principles to assess the economic viability of each strategy.

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    Main Results:

    • The "visual field strategy" is deemed cost-effective only when perimetrists can accurately identify hemianopic field defects in over 80% of cases.
    • Current diagnostic accuracy of perimetrists in identifying such defects is likely insufficient to meet this cost-effectiveness threshold.

    Conclusions:

    • The "visual field strategy" for unexplained visual loss is not currently cost-effective given typical diagnostic accuracy rates.
    • Limitations include tentative conclusions due to weak epidemiologic data and potential inaccuracies in reflecting patient valuations in cost assessments.
    • Cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA) encourage greater cost-consciousness and further epidemiologic research in medical problem-solving.