Use of Number Needed to Treat in Cost-Effectiveness Analyses

Summary

We reviewed the literature to identify studies that reported results of CEAs along with NNT and/or NNH. We found that CEA studies incorporating NNT are generally published in clinician-practice-focused journals, but represent a small proportion of total published CEAs. Furthermore, only 14.5% and 4.3% of the CEA articles incorporating NNT focused on disease management and educational interventions, respectively. Since NNT/NNH are often used as decision tools by clinicians, it may increase clinical relevance and application of CEA results to include this information. Increased understanding of relationships between CEA and NNT/NNH may help clinicians apply CEA findings in practice. We recommend further research to explore whether NNT/NNH could be meaningfully incorporated into health economic evaluation studies.

Table 1. Classification of 69 Reviewed Studies
Classification	Parameter	Articles,n (%)	Citations
Journal type	Health-economics-focused	11 (15.9)	68–78
	Policy-focused	4 (5.8)	79–82
	Clinician-practice-focused	54 (78.3)	18–67, 83–87
Journal impact factor	0–3	19 (27.5)	20, 36, 37, 40, 43, 46–48, 50–52, 54, 58, 61, 62, 65, 67, 68, 87
	>3–10	44 (63.7)	18, 19, 21, 22, 25, 29–35, 38, 39, 41, 42, 44, 45, 49, 53, 55–57, 59, 60, 63, 64, 66, 69–73, 75–86
	>10	6 (8.7)	23, 24, 26–28, 74
Study focus	Patient education	3 (4.3)	42, 64, 87
	Disease prevention	28 (40.5)	18, 21, 22, 24–26, 30, 31, 34, 37, 38, 41, 46, 52, 53, 57, 59, 61–63, 68, 70–72, 76, 81, 84, 85
	Disease treatment	28 (40.5)	19, 20, 32, 33, 36, 39, 40, 43–45, 47, 48, 50, 51, 54, 55, 58, 60, 65–67, 74, 75, 77, 79, 80, 82, 86
	Disease management	10 (14.5)	23, 27–29, 35, 49, 56, 69, 73, 78, 83
Ways NNT incorporated in CEA	NNT separated from CEA based on QALY	17 (24.6)	23, 27, 35, 37, 41, 43, 45, 46, 48, 54, 56, 77–81, 83
	NNT separated from CEA based on events	19 (27.5)	18, 19, 24–26, 28, 33, 39, 40, 59, 62, 67, 71, 72, 74, 76, 84–86
	NNT reported with CEA ratio	33 (47.8)	20–22, 29–32, 34, 36, 38, 42, 44, 47, 49–53, 55, 57, 58, 60, 61, 63–66, 68–70, 73, 75, 82, 87
Data sources	Literature summary	37 (53.6)	18, 19, 21–25, 32, 34–37, 40, 41, 43, 45, 47, 53, 56, 57, 61, 62, 64, 65, 68–71, 73, 74, 76–78, 81–86
	Observational studies	14 (20.3)	20, 27, 31, 44, 50–52, 54, 55, 59, 60, 63, 66, 67
	RCTs conducted for purpose	6 (8.7)	28–30, 38, 58, 87 of CEA
	RCTs with primary purpose other than CEA	12 (15.9)	26, 33, 39, 42, 46, 48, 49,58, 72, 75, 79, 80

Table 1. Classification of 69 Reviewed Studies

Classification

Parameter

Articles,n (%)

Citations

Journal type

Health-economics-focused

11 (15.9)

68–78

Policy-focused

4 (5.8)

79–82

Clinician-practice-focused

54 (78.3)

18–67, 83–87

Journal impact factor

0–3

19 (27.5)

20, 36, 37, 40, 43, 46–48, 50–52, 54, 58, 61, 62, 65, 67, 68, 87

>3–10

44 (63.7)

18, 19, 21, 22, 25, 29–35, 38, 39, 41, 42, 44, 45, 49, 53, 55–57, 59, 60, 63, 64, 66, 69–73, 75–86

>10

6 (8.7)

23, 24, 26–28, 74

Study focus

Patient education

3 (4.3)

42, 64, 87

Disease prevention

28 (40.5)

18, 21, 22, 24–26, 30, 31, 34, 37, 38, 41, 46, 52, 53, 57, 59, 61–63, 68, 70–72, 76, 81, 84, 85

Disease treatment

28 (40.5)

19, 20, 32, 33, 36, 39, 40, 43–45, 47, 48, 50, 51, 54, 55, 58, 60, 65–67, 74, 75, 77, 79, 80, 82, 86

Disease management

10 (14.5)

23, 27–29, 35, 49, 56, 69, 73, 78, 83

Ways NNT incorporated in CEA

NNT separated from CEA based on QALY

17 (24.6)

23, 27, 35, 37, 41, 43, 45, 46, 48, 54, 56, 77–81, 83

NNT separated from CEA based on events

19 (27.5)

18, 19, 24–26, 28, 33, 39, 40, 59, 62, 67, 71, 72, 74, 76, 84–86

NNT reported with CEA ratio

33 (47.8)

20–22, 29–32, 34, 36, 38, 42, 44, 47, 49–53, 55, 57, 58, 60, 61, 63–66, 68–70, 73, 75, 82, 87

Data sources

Literature summary

37 (53.6)

18, 19, 21–25, 32, 34–37, 40, 41, 43, 45, 47, 53, 56, 57, 61, 62, 64, 65, 68–71, 73, 74, 76–78, 81–86

Observational studies

14 (20.3)

20, 27, 31, 44, 50–52, 54, 55, 59, 60, 63, 66, 67

RCTs conducted for purpose

6 (8.7)

28–30, 38, 58, 87 of CEA

RCTs with primary purpose other than CEA

12 (15.9)

26, 33, 39, 42, 46, 48, 49,58, 72, 75, 79, 80

Use of Number Needed to Treat in Cost-effectiveness Analyses

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