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FAST STATS A 5-minute Review for the Evidence-Based Practitioner

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When evaluating medical literature, there are two important concepts absolute risk vs. relative risk number needed to treat

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Relative Risk (RR) compares the probability of an event occurring in the exposed group vs. the non-exposed group. Absolute Risk & Relative Risk Absolute Risk (AR) describes the incidence of a condition in a population.

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Example: Drug A prevents heart attacks (MIs) but also increases the risk of lung cancer. A placebo-controlled trial in 200 people (100 in each arm) found that there were three heart attacks in the treated group and six heart attacks in the placebo group. There were three cases of lung cancer in the treated group, and one in the placebo group. Drug APlacebo MIs 36 Lung Ca 31 Absolute Risk & Relative Risk

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We might say that Drug A reduces heart attack risk by 50% or cuts heart attack rate in half. We could also say that the heart attack risk is reduced by 3%.

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Drug APlacebo MIs 36 Lung Ca 31 Absolute Risk & Relative Risk We could also say that lung cancer risk increases by 2%. We could say that the lung cancer risk increases by 200%.

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Absolute risk makes risks or benefits look smaller. Relative risk makes risks or benefits look bigger. Absolute Risk & Relative Risk

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To be fair, both harms and benefits should be presented in absolute terms or relative terms. Absolute Risk & Relative Risk

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Number Needed to Treat (NNT) is an important means of evaluating data. NNT is calculated by taking the reciprocal of the absolute difference between experimental groups. Another way is by dividing 100 by absolute risk. Number Needed to Treat

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3% of the treatment group and 6% of the control group had heart attacks. The absolute difference is 3% because 6%-3%= 3% = 0.03 That means that 33 people must be treated with this drug to prevent one heart attack. -OR- Number Needed to Treat

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Number Needed to Harm (NNH) is also calculated by taking the reciprocal of the absolute difference between experimental groups. Another way is by dividing 100 by absolute risk. Number Needed to Harm

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3% of the treatment group developed lung cancer, compared to 1% of the placebo group. The absolute difference is 2% or 0.02. So the NNH is 50, meaning that we would expect one additional case of lung cancer for every 50 people treated with Drug A. -OR- Number Needed to Harm

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Drug APlacebo MIs 36 Lung Ca 31 One out of every 33 people treated with Drug A will be spared a heart attack; however, one out of every 50 people will develop lung cancer caused by Drug A. NNT vs. NNH

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Now you understand the difference between absolute and relative risk, and you can calculate NNT and NNH. This information will help you make evidence-based decisions for your practice. Congratulations!

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PharmedOut is a Georgetown University Medical Center project that advances evidence-based prescribing, and educates healthcare professionals about pharmaceutical marketing practices. Learn more about us at http://pharmedout.org/aboutus.htm. http://pharmedout.org/aboutus.htm Cover art by Andrea Sikora, inspired by Wojtek Kozak Presentation layout by Andrea Sikora and Grace Doan Nov 2011 version 2.4

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