In message <[log in to unmask]>, "Toby Lipman 7,
Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel 0191-2811060
(home), 0191-2869178 (surgery)" <[log in to unmask]> writes
>In message <[log in to unmask]>, Ruth Livingstone
><[log in to unmask]> writes
>>Buried in the bulletin of
>> Effective Health Care, Feb 98, vol 4 no 1, ISSN: 0965-0288
>>from the NHS Centre for Reviews and Dissemination,
>>University of York, page 7
>>
>>"Further important trial results are awaited which appear
>>likely to extend the range of indications for use of statins.
>>The next trial to report will be the Air Force/Texas Coronary
>>Atherosclerosis prevention Study of lovastatin in 6605 people
>>(15% women) with no evidence of coronary heart disease and
>> with average blood cholesterol levels. This trial was stopped
>>early after finding a 36% reduction in the combined fatal and
>>non-fatal CHS endpoint."
>>
>>So, this trial was stopped because it was deemed unethical
>>to continue NOT treating people with statins.
>>Implications are - statins for everyone !!!!
>>
>Yup - well that fits in with other statin trials which show similar
>relative risk reductions. The point is, what is the absolute risk
>reduction? If a population has a prevalence of CHD events of say 20%,
>then a 36% relative risk reduction means there will be an absolute risk
>reduction of (quick and inaccurate mental arithmetic) 7%. The number
>needed to treat (NNT) is 1/ARR=100/7=14. Quite useful. But if the
>background risk is 1% (say in a young, fit population which doesn't
>smoke) then the absolute risk reduction will be 0.36%, which is peanuts.
>The number needed to treat here is 100/0.36=c300 - pretty useless, or at
>least expensive. I don't know the cost of lovastatin, but say it's
>UKP250 a year, and the risk reduction is expressed as events in a year
>(I'm assuming these figures), then the cost per event treated is around
>ukp250x300= UKP75,000 for your low risk population, but only
>UKP250x14=UKP3,500.
>
Sorry - this is dreadful English! Its cost per event *prevented* - high
risk UKP3,500, low risk UKP75,000
(grovels at having sent such an incomprehensible message)
>It depends how rich your country is as to what level of risk you can
>afford to treat.
>
>Cheers
>
>Toby
--
Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel
0191-2811060 (home), 0191-2437000 (surgery)
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