Dear all
I think a point made in passing in the original paper
deserves more attention, that of the relevance of NNTs to
cost-effectiveness results. Whilst I agree that NNTs are
perilously easy to misuse, their limitations illuminate the
much glossed-over issue of "How should decision-makers
interpret and use cost-effectiveness results in THEIR
setting?"
If one accepts cost-effectiveness as a part of
priority-setting then one must recognise the part NNTs
play: the incremental cost-effectiveness ratio of a
treatment is the additional costs of that treatment
multiplied by the NNT. Too often the "one size fits all"
argument is used, i.e. cost-effectiveness in this setting
means it's OK in another. By highlighting the large caveats
surrounding NNTs we force decisionmakers/clinicians to
explicitly recognise the heterogeneity across patients and
settings and the need for group-specific
cost-effectiveness data. Thus the shortcomings of the NNT
are also, in a sense, its strength. Perhaps the moral is
don't throw away the baby with the bathwater.
cheers
Terry
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Terry Flynn
MRC PhD Student
Department of Social Medicine
University of Bristol
Canynge Hall
Whiteladies Road
Bristol BS8 2PR
Tel: 0117 928 7375
E-mail: [log in to unmask]
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