Decisions on drug therapies by numbers needed to treat - A randomized trial
Decisions on drug therapies by numbers needed to treat - A randomized trial
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DOI：
10.1001/archinte.165.10.1140
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发表时间：
2005-05-23
影响因子：
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通讯作者：
Kristiansen, IS
中科院分区：
文献类型：
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作者：
Halvorsen, PA;Kristiansen, IS
背景：当患者和医生共同决策时，需要治疗的数量(NNT)已被推广为首选的效果衡量标准。本研究的目的是探讨NNT对普通人预防性药物治疗决策的影响。方法：选择2000名调查对象，其中1201人(60%)回答了挪威人口中具有代表性的样本。受访者被分配到要预防的疾病、药物治疗成本和NNT效果大小的随机组合的情景中。结果：同意治疗的比例从NNT为50时的76%到NNT为1600时的67%(趋势=.06)。当面对避免致命疾病、中风、心肌梗死或髋部骨折的前景时，同意的比例分别为84%、76%、68%和53%(P<；.01)。在不同的治疗费用(37美元、68美元、162美元和589美元)中，同意的比例从78%到61%不等(P为Trend<；.01)。24%的受访者在被告知如何解释NNT时改变了他们的决定，93%的人从积极的决定转变为消极的决定，无论NNT的大小。结论：受访者的决定受到要预防的疾病类型和干预费用的影响，但不受NNT影响的大小。这表明NNT很难理解，为了共同决策，应该考虑其他影响格式。
Background: The number needed to treat (NNT) has been promoted as the preferred effect measure when patients and physicians share decision making. Our aim was to explore the impact of the NNT on laypeople's decisions about preventive drug therapies.Methods: Two thousand subjects were selected for the survey; 1201 (60%) responded for a representative sample of the Norwegian population. Respondents were allocated to scenarios with random combinations of a disease to be prevented, drug treatment costs, and effect size in terms of NNT. They were interviewed about their hypothetical consent to the therapy, then randomized to different interpretations of NNT and asked to reconsider their initial responses.Results: The proportions consenting varied from 76% when the NNT was 50 to 67% when the NNT was 1600 (P for trend = .06). When faced with the prospect of avoiding lethal disease, stroke, myocardial infarction, or hip fracture, the proportions consenting were 84%, 76%, 68%, and 53%, respectively (P < .01). Across different treatment costs ($37, $68, $162, and $589) the proportions consenting varied from 78% to 61% (P for trend < .01). Twenty-four percent of the respondents changed their decision when informed about how to interpret the NNT, and 93% of those switched from positive to negative decisions, regardless of the magnitude of NNT.Conclusions: Respondents' decisions were influenced by the type of disease to be prevented and the cost of the intervention, but not by the effect size in terms of NNT. This suggests that NNT is difficult to understand and that other effect formats should be considered for shared decision making.