治疗决策所需人数和生存获益：降脂药物推荐的横断面调查。

Therapeutic decisions by number needed to treat and survival gains: a cross-sectional survey of lipid-lowering drug recommendations.

机构信息

National Centre of Rural Medicine, Institute of Community Medicine, University of Tromsø, Tromsø, Norway.

出版信息

Br J Gen Pract. 2011 Aug;61(589):e477-83. doi: 10.3399/bjgp11X588448.

DOI:10.3399/bjgp11X588448

PMID:21801540

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3145531/

Abstract

BACKGROUND

Previous studies suggest that lay people have difficulties with evaluating effect size in terms of number needed to treat (NNT), but they are sensitive to effect size in terms of survival gains.

AIM

To explore whether GPs and internists are sensitive to NNT and survival gains when considering a lipid-lowering drug therapy.

DESIGN AND SETTING

Cross-sectional survey of primary prevention of cardiovascular disease with random allocation to different scenarios.

METHOD

GPs (n = 450) and internists (n = 450) were posted a vignette presenting a high-risk patient and a novel drug, 'neostatin'. The benefit was described in terms of NNT or mean gain in disease-free survival. Each physician was randomly allocated to one version of the vignette. Outcome measures were evaluation of 'neostatin' on a Likert scale (0: very poor choice, 10: very good choice) and the proportion recommending 'neostatin'.

RESULTS

A total of 477 responses (53%) were received. Among responders to NNT scenarios, 26%, 31%, and 43% recommended 'neostatin' for NNT values of 34, 17, and 9 respectively. With equivalent disease-free survival gains of 9, 17, and 32 months, 40%, 49%, and 52% respectively recommended the drug. On the rating scale, mean values were 4.7, 5.0, and 5.5 across the respective NNT scenarios and 5.2, 6.2, and 6.1 across the scenarios presenting survival gains. Differences in trends between the two formats were not statistically significant. In total, 33% recommended 'neostatin' when presented with NNT values, compared to 47% when presented with survival gain (χ(2) = 9.2, P= 0.002).

CONCLUSION

Physicians presented with survival gains were more likely to recommend the therapy than those presented with NNT. Sensitivity to effect size was similar for both effect formats.

摘要

背景

先前的研究表明，非专业人士在评估需要治疗的人数（NNT）方面存在困难，但他们对生存获益方面的效果大小很敏感。

目的

探讨全科医生和内科医生在考虑降脂药物治疗时，是否对 NNT 和生存获益敏感。

设计和设置

以心血管疾病一级预防为背景，采用横断面调查，对不同场景进行随机分配。

方法

向 450 名全科医生和 450 名内科医生发送一份病例报告，介绍一名高危患者和一种新型药物“neostatin”。益处用 NNT 或无病生存的平均获益来描述。每位医生随机分配到病例报告的一个版本。结果测量是用李克特量表（0：非常差的选择，10：非常好的选择）评估“neostatin”和推荐“neostatin”的比例。

结果

共收到 477 份回复（53%）。在 NNT 场景的回复者中，NNT 值分别为 34、17 和 9 时，分别有 26%、31%和 43%推荐“neostatin”。当无病生存获益分别为 9、17 和 32 个月时，分别有 40%、49%和 52%推荐该药物。在评分量表上，相应 NNT 场景的平均值分别为 4.7、5.0 和 5.5，呈现生存获益的场景分别为 5.2、6.2 和 6.1。两种格式的趋势差异没有统计学意义。当呈现 NNT 值时，有 33%的人推荐“neostatin”，而当呈现生存获益时，有 47%的人推荐（χ(2) = 9.2，P = 0.002）。