O número necessário para tratar (NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat) é o número de pacientes que é necessário tratar para prevenir 1 resultado adverso adicional (por exemplo, acidente vascular cerebral, morte). Por exemplo, se um fármaco tem um NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat de 10, significa que têm de ser tratadas 10 pessoas com o fármaco para evitar 1 resultado adverso adicional. O NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat é o inverso da redução do risco absoluto (ARR, pela sigla em inglês), que é igual à taxa de eventos adversos ocorridos no grupo de controlo menos o número de resultados adversos no grupo experimental.
O número necessário para tratar (NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat), também chamado número necessário para beneficiar (NNTB, pela sigla em inglês); e seu análogo, o número necessário para causar dano (NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat, pela sigla em inglês), são simplesmente outras medidas de tamanhos de efeito, como o d de Cohen, e ajudam a relacionar uma diferença de tamanho de efeito com a relevância clínica do mundo real.
Número necessário para tratar
O NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat significa quantos pacientes precisariam de ser tratados para melhorar 1 paciente adicional, que de outra forma não teria melhorado sem esse tratamento específico.
O inverso da redução de risco absoluto (ARR, pela sigla em inglês) = 1/ARR
NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat é um número entre 1 e infinito:
As frações são arredondadas para o número inteiro seguinte.
Um NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat perfeito seria 1, o que significa que para cada paciente tratado, 1 melhorou no ensaio, que não teria de outra forma sem aquele tratamento específico.
Redução do risco absoluto, diferença do risco absoluto (ARD, pela sigla em inglês) e excesso de risco absoluto (ARE, pela sigla em inglês)
Todos os termos representam o valor absoluto da diferença entre a proporção (expressa como percentagem, fração ou incidência) de pacientes do grupo de controlo (Pc) que tiveram o desfecho de interesse e a proporção de pacientes do grupo experimental (Pe) com o desfecho de interesse:
Deve ser interpretado em contexto: Uma estimativa pontual de NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat isolada tem pouco valor, embora aproximadamente 50% dos ensaios clínicos não forneçam as informações contextuais necessárias.
O NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat usa a ARR e não a redução do risco relativo (RRRRRRMeasures of Risk), o que tende a sobrenfatizar o benefício.
Por exemplo, se o risco inicial fosse de 0,2% e o fármaco X reduzisse esse risco para 0,1%, a RRRRRRMeasures of Risk ainda seria de 50%, mas a ARR seria de apenas 0,1%, o que não é muita diferença da linha de base.
Como a RRRRRRMeasures of Risk está diretamente correlacionada com a ARR, o NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat também está inversamente correlacionado com a RRRRRRMeasures of Risk.
O NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat informa quantos pacientes seriam beneficiados, mas não informa em quanto se poderiam beneficiar. As respostas para as seguintes perguntas devem ser fornecidas com o NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat para o interpretar integralmente:
Qual é o risco inicial dos pacientes no estudo?
Qual é o comparador? (por exemplo, nenhum tratamento? placeboPlaceboAny dummy medication or treatment. Although placebos originally were medicinal preparations having no specific pharmacological activity against a targeted condition, the concept has been extended to include treatments or procedures, especially those administered to control groups in clinical trials in order to provide baseline measurements for the experimental protocol.Epidemiological Studies? outra terapia?)
Qual é o resultado? (por exemplo, cura completa? 30% de melhoria?)
Quanto tempo dura o estudo? (deve ser incluído com o NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat)
Qual é o intervalo de confiança?
Interpretação
Quanto menor o NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat, melhor; quanto maior o NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat, menos pessoas serão ajudadas.
As intervenções de tratamento que têm um NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat em um ou dois dígitos baixos são geralmente consideradas eficazes para o tratamento de doenças sintomáticas.
Para desfechos com alta significância clínica, como prevenção de morte, um NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat abaixo de 100s também pode ser considerado útil.
Para terapias preventivas, os NNTs também podem ser altos.
Número Necessário para Prejudicar
O NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat é o número adicional de indivíduos que precisariam de ser expostos ao risco (exposição prejudicial ou tratamento) para que 1 pessoa a maisMAISAndrogen Insensitivity Syndrome desenvolva a doença em comparação com o grupo não exposto.
NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat é o inverso do ARE (1/ARE).
Relação entre o NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat e o NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat: Um NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat negativo indica que o tratamento tem um efeito prejudicial. Por exemplo, um NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat de -10 indica que se 10 pacientes forem tratados com o novo tratamento, seria prejudicada uma pessoa adicional em comparação com os pacientes que fazem o tratamento padrão, ou seja, o NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat = 10.
Como NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat, o NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat deve ser interpretado no contexto.
Calcular o NNT e o NNH
A base para o cálculo do NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat e do NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat
Uma tabela de contingência 2 x 2 usa um resultado binário e 2 grupos de indivíduos para mostrar a base para o cálculo do NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat e do NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat. Cada resultado deve ser expresso como uma proporção, uma percentagem ou uma incidência, e não como o número real de indivíduos.
Resultado
Grupo tratado
Grupo de controlo
Positivo
a
b
Negativo
c
d
Total
a + c
b + d
Esta tabela de contingência 2 x 2 usa um resultado binário e 2 grupos de indivíduos para mostrar a base para o cálculo do NNT e do NNH. Cada resultado deve ser expresso como uma proporção, uma percentagem ou uma incidência, e não como o número real de indivíduos. NNT: número necessário para tratar NNH: número necessário para prejudicar
Se o seguinte for verdadeiro, a diferença nas proporções é P tratado – P controlo.
P tratado = a proporção de indivíduos com resultado positivo no grupo tratado
P tratado = a/(a + b)
P controlo = a proporção de indivíduos com resultado positivo no grupo de controlo
P controlo = b/(b + d)
A diferença de risco absoluto (ARD, pela sigla em inglês) é igual à ARR, que é calculada como o valor absoluto da diferença entre P tratado e P controlo.
Assim, o NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat pode ser calculado como:
Se o grupo tratado ou exposto tiver um resultado pior do que o de controlo, a ARR é chamada de ARE. Neste caso, o NNTNNTThe number needed to treat (NNT) is the number of patients that are needed to treat to prevent 1 additional adverse outcome (e.g., stroke, death). For example, if a drug has an nnt of 10, it means 10 people must be treated with the drug to prevent 1 additional adverse outcome.Number Needed to Treat é chamado de número necessário para prejudicar (NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat). Em ambos os casos, o cálculo é o mesmo (NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat = 1/ARD).
Questões Práticas
Um ensaio clínico aleatorizado estudou o efeito da exposição infantil ao fumo passivo na incidência de adenocarcinoma broncogénico (AB). O estudo incluiu 100 indivíduos (50 expostos ao fumo passivo na infância e 50 controlos saudáveis sem exposição na infância) e envolveu a monitorização da incidência de AB ao longo da vida. Os dados do estudo são mostrados na tabela abaixo:
Resultado
Grupo exposto
Grupo de controlo
AB presente
18
7
AB não presente
32
43
Total
50
50
AB: adenocarcinoma broncogénico
Questão 1
Qual é o NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat?
Resposta:NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat = 1/diferença de risco absoluto (chamada “ARE” quando o NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat está envolvido). ARE = Pe – Pc = 18/50 – 7/50 = 0,22. NNHNNHThe NNH is the additional number of individuals who need to be exposed to risk (harmful exposure or treatment) to have 1 extra person develop the disease compared to that in the unexposed group.Number Needed to Treat = 1/0,22 = 4,45 ⇾ 5, o que significa que precisam de ser expostos 5 indivíduos ao fumo passivo na infância para que 1 pessoa a maisMAISAndrogen Insensitivity Syndrome desenvolva AB em comparação com o grupo não exposto.
Questão 2
Qual é o aumento do risco relativo no estudo citado na pergunta 1?
Resposta: O aumento do risco relativo = (Pe – Pc)/Pc = (18/50 – 7/50)/7/50 = 1,57, o que significa que indivíduos expostos ao fumo passivo na infância têm 1,57 vezes maisMAISAndrogen Insensitivity Syndrome probabilidade de desenvolver AB após exposição ao fumo passivo do que aqueles que não foram expostos.
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