Which Treatment ?

 For a patient, 64-year-old male

 No HT, DM, Heart failure, LV dysfunction
 Having non-rheumatic atrial fibrillation
 Treatment ‘A’ reduces annual stroke risk by 40%
 Treatment ‘B’ requires 250 patients to be treated
for one year to prevent one stroke
 Treatment ‘C’ reduces annual stroke risk from
1.0% to 0.6%
 Newspaper headlines: Economic
reforms succeed
 Economic reforms led to decline in
unemployment from 20% to 15%, thus
reducing it by 25%
 Newspaper headlines: Economic
reforms succeed
 Economic reforms led to decline in
unemployment from 20% to 15%, thus
reducing it by 25%.
 How? Difference is only 5%.
 If 20% = 100%
 Then 15% = 75%
 And 5% = 25%
Different ways of expressing effects
 Economic reforms led to decline in
unemployment rate from 20% to 15%,
thus reducing it by 25%
 20% - 15% = 5% Absolute risk reduction
 If 20% = 100% Baseline risk
 Then 15% = 75% Relative risk
 And 5% = 25% Relative risk reduction
 In an Intervention trial
 Intervention led to decline in risk (incidence) of
mortality from 20% (in control group) to 15%
(in intervention group), thus reducing it by
25%.
 Risk Difference is the simple difference between
the two risks = 5%.
 If 20% is taken as 100%, then
 15=75% = RR (15%/20%=0.75=75%)
 And 5% = 25% i.e. RRR (100-75 i.e. 100-RR
(%) or in decimals, 1 - RR
 What does risk difference of 5% mean?
 5 per cent = 5 per 100,
 5 less death per 100 need to be treated
with new t/t
 To have one less death, how many need to
be treated?
 What if Risk difference is 10%; 20%; 50%
 NNT = 100/RD (%); in decimals 1/RD
 A True Story
 Husband and pregnant wife meet their doctor
 Husband asks : When is the delivery expected
doctor?
 Doctor : What’s the LMP
 Wife : 1st March 2009
 Doctor : EDD is 8th December 2009
 Husband : OK, I will be here on 7th Dec. 2009
 Doctor : Oh sorry, the delivery may be earlier or
later than 7th Dec.
 And so on
 Degree of desired confidence level
determines the width of the range
(Interval)
Similarities b/w EDD range and C.I.

 Both need data and calculation

 Both capture the margin of error
 Both indicate range of possibilities
 Width of the range is directly related to
the desired level of certainty
 This is only one point of true or right value
in both
 Differences b/w EDD range & C.I.
 EDD predicts about individual whereas C.I.
about population
 No definite formula for EDD but for every
C.I. there is definite formula
 Formula for C.I. differs depending on the
type of data (no such for EDD)
 Width of C.I. inversely related to sample
size (? In EDD)
 Newspaper headlines
 Barack Obama’s popularity rating is 55%
(error +/- 10%)
 How to reduce the error?
 Bigger the sample size, less the error; and
narrower is the width of CI
 How much width of CI is acceptable?
 45% (error +/- 10%)
 65% +/- 10%
 Two more concepts
 Width of CI at a level (say 95%) depends
on the sample size

 Bigger the sample size, narrower the CI

 A good width of CI is the one which yields

the same answer at both its ends (limits)
 What is 95% confidence
interval?
 95% confident that the true effect is within
the range

 A point in the centre is the finding from the

study subjects

 Lines on either side denote the margin of error

(range of values consistent with the data)
 Interventions Q vs Placebo Study D (N=4000) (-0.1% to - 2%)

Interventions P vs Placebo
Study Q (N=400) (-1% to - 19%)

-50 -40 -30 -20 -10 0 10 20 30 40 50

Risk difference
95% C.I. For two studies with small (C) and Large (D)
sample size. p values approx 0.03 for both studies
 Interventions Y vs Placebo
Study B (-0.1% to + 0.1%)
(N=10,000)
Interventions X vs Placebo Study A (N=20) (-48% to + 48%)

-50 -40 -30 -20 -10 0 10 20 30 40 50

Risk difference
95% C.I. For two studies with small (A) and
Large (B) sample size. p values 1.0 for both
studies
THANK YOU