I read with great interest the report of the LIPID study in NEJM this week
(more stuff about how great pravastatin is at prolonging lives of sufferers
of IHD).
Now before you start jumping down my neck on the assumption in brackets
above, let me confess; I *haven't* done a full critical reading of this
paper.
I was struck by the way benefits were expressed; "lives saved", "deaths
prevented", "strokes prevented" and so forth.
The point is that we never **prevent** a death; only defer it.
So to talk about NNT to prevent a death is surely a misnomer; the issue is
going to be influenced by the change in life expectancy.
Exactly similar arguments apply towards recurrent coronary events, strokes,
coronary mortality etc
I had a look at the Kaplan-Meier curves on page 1353 with this in mind. If
you look at the first curve, say; this *seems* to suggest that the average
life expectancy (all cause mortality) of the pravastatin group was a tad
under a year longer than the placebo group after five-six years. Is this
right? If it is, it suggests quite good value in terms of cost per QALY
gained ... ??
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Dr Joe Neary,
Primary Care Resource Centre
c/o Trinity Surgery
Wisbech, Cambs, PE13 3UZ
Tel: 01945-476999 Fax: 01945-476900
e-mail: [log in to unmask]
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