TY - JOUR
T1 - Years-needed-to-treat to add 1 year of life: a new metric to estimate treatment effects in randomized trials
AU - Levy, Wayne C
AU - Mozaffarian, Dariush
AU - Linker, David T
AU - Kenyon, Kenneth W
AU - Cleland, John G F
AU - Komajda, Michel
AU - Remme, Willem J
AU - Torp-Pedersen, Christian
AU - Metra, Marco
AU - Poole-Wilson, Philip A
AU - COMET Investigators
AU - Levy, Wayne C
AU - Mozaffarian, Dariush
AU - Linker, David T
AU - Kenyon, Kenneth W
AU - Cleland, John G F
AU - Komajda, Michel
AU - Remme, Willem J
AU - Torp-Pedersen, Christian
AU - Metra, Marco
AU - Poole-Wilson, Philip A
AU - COMET Investigators
N1 - Keywords: Adrenergic beta-Antagonists; Carbazoles; Confidence Intervals; Follow-Up Studies; Heart Failure; Humans; Kaplan-Meiers Estimate; Life Expectancy; Metoprolol; Odds Ratio; Propanolamines; Survival Rate; Time Factors; Treatment Outcome
PY - 2009/3/1
Y1 - 2009/3/1
N2 - AIMS: A standard metric to estimate absolute treatment effects is numbers-needed-to-treat (NNT), which implicitly assumes that all benefits reverse at trial-end. However, in-trial survival benefits typically do not reverse until long after trial-end, so that NNT will substantially underestimate lifetime benefits. METHODS AND RESULTS: We developed a new concept, years-needed-to-treat (YNT) to add 1 year of life, that quantifies the expected average life expectancy for two treatments including the estimated years of life remaining post-trial. Numbers-needed-to-treat and YNT were calculated in the COMET trial, in which carvedilol vs. metoprolol tartrate resulted in 17% lower mortality over 4.8 years. A multivariate Cox model was used to predict survival. Remaining years of life were estimated using the mortality-life-table method. At trial-end, survival was 9% higher in the carvedilol arm. Assuming that patients remained on the same therapy post-trial, the average total years of life for carvedilol vs. metoprolol were 10.63 +/- 0.19 vs. 9.48 +/- 0.18 (P < 0.0001) or 1.15 (95% confidence interval 0.64-1.66) additional years of life. The YNT was 9.2, indicating that 9.2 person-years of treatment added 1 person-year of life, compared with NNT of 59. CONCLUSION: Compared with NNT, the YNT method more accurately accounts for potential long-term benefits of interventions in randomized trials.
AB - AIMS: A standard metric to estimate absolute treatment effects is numbers-needed-to-treat (NNT), which implicitly assumes that all benefits reverse at trial-end. However, in-trial survival benefits typically do not reverse until long after trial-end, so that NNT will substantially underestimate lifetime benefits. METHODS AND RESULTS: We developed a new concept, years-needed-to-treat (YNT) to add 1 year of life, that quantifies the expected average life expectancy for two treatments including the estimated years of life remaining post-trial. Numbers-needed-to-treat and YNT were calculated in the COMET trial, in which carvedilol vs. metoprolol tartrate resulted in 17% lower mortality over 4.8 years. A multivariate Cox model was used to predict survival. Remaining years of life were estimated using the mortality-life-table method. At trial-end, survival was 9% higher in the carvedilol arm. Assuming that patients remained on the same therapy post-trial, the average total years of life for carvedilol vs. metoprolol were 10.63 +/- 0.19 vs. 9.48 +/- 0.18 (P < 0.0001) or 1.15 (95% confidence interval 0.64-1.66) additional years of life. The YNT was 9.2, indicating that 9.2 person-years of treatment added 1 person-year of life, compared with NNT of 59. CONCLUSION: Compared with NNT, the YNT method more accurately accounts for potential long-term benefits of interventions in randomized trials.
U2 - 10.1093/eurjhf/hfn048
DO - 10.1093/eurjhf/hfn048
M3 - Journal article
C2 - 19164422
SN - 1567-4215
VL - 11
SP - 256
EP - 263
JO - European Journal of Heart Failure, Supplement
JF - European Journal of Heart Failure, Supplement
IS - 3
ER -
