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# How to derive the Number Needed to Treat from a clinical trial.

This method assumes the trial has shown a statistically significant benefit of one
treatment over another, or compared to no treatment. The trial should have one
outcome identified as the primary outcome measure, and may report secondary
outcomes as well. The NNT calculation is specific to each outcome measure, and
for long term treatments must also indicate a time period.
1. Identify the proportion of subjects in the control group with the outcome,
expressed as a percentage.
2. Identify the proportion of subjects in the treatment group with the
outcome, expressed as a percentage.
3. Subtract %2 from %1 to give the difference in outcomes. Still expressed as
a percentage.
4. Divide 100 by the number from step 3.
5. Formulate this into a NNT statement including the outcome and the time
period.
Authors vary in the way outcomes are presented in a paper:
If they report survival, you must covert this into deaths or events, eg 70%
survival means 30% deaths.
If they report outcomes as annual incidence this can be used directly in steps 1 &
2.

EXAMPLE
In the 1991 SOLVD treatment trial heart failure patients with EF <35 were
randomised to Enalapril (n=1285) or placebo (n=1284) and followed up for 3.5
years. Lots died.
Controls: 510/1284 = 39.72%
Enalapril:452 / 1285 = 35.18%
Difference: 4.54 %
NNT = 100/4.54 = 22.03
Statement: In these patients, treatment with Enalapril prevented one death for
every 22 people treated for 3.5 years.
Notes: In epidemiologic language, NNT is the reciprocal of the absolute risk
difference. While the relative risk is generally the metric used to test if the
treatment has a statistically significant benefit, the absolute risk difference is
more use when evaluating the usefulness of the treatment, and for discussion
with clinicians and patients. The same arithmetic can be used to quantify harms,
Number Needed to Harm (NNH) or the benefit of screening programs, Number
Needed to Screen to prevent one outcome.