I could add that, in the process of making individual evidence-based decisions, when we have clinically significant efficacy (OR for the primary outcome of benefit) and safety (OR for the primary adverse effect) demonstrated by sufficiently valid evidence, the decision should not be driven prim…
I could add that, in the process of making individual evidence-based decisions, when we have clinically significant efficacy (OR for the primary outcome of benefit) and safety (OR for the primary adverse effect) demonstrated by sufficiently valid evidence, the decision should not be driven primarily by efficacy. Instead, it should be based on the balance of benefit and risk for the specific patient. This is determined by estimating the baseline risk of outcomes in our patient and adjusting the patient’s NNT accordingly.
For example, suppose my healthy patient, given their background, has an estimated risk of hospitalization due to RSV of 0.1%. In the European Drysdale et al study, in healthy infants ≤12 months of age. RSV hospitalizations were significantly reduced by 83.3%.
What would be the NNT for my patient if I administer Nirsevimab?
Answer: Adjust the efficacy from the study (83%) based on my patient’s baseline risk (0.1% or 1 in 1,000) of experiencing an RSV hospitalization. This gives the Absolute Risk Reduction (ARR) for my patient= 0,083
Then, calculate the NNT by taking the inverse: 100/0,083=1.204,819 1204 that is NNT adjusted to my patient’s risk).
Is it justifiable for the mother or father that it would be necessary to administer the medication to 1204 patients like mine to prevent one hospitalization due to or associated with RSV?
Excellent analysis Dharini, congratulations.
I could add that, in the process of making individual evidence-based decisions, when we have clinically significant efficacy (OR for the primary outcome of benefit) and safety (OR for the primary adverse effect) demonstrated by sufficiently valid evidence, the decision should not be driven primarily by efficacy. Instead, it should be based on the balance of benefit and risk for the specific patient. This is determined by estimating the baseline risk of outcomes in our patient and adjusting the patient’s NNT accordingly.
For example, suppose my healthy patient, given their background, has an estimated risk of hospitalization due to RSV of 0.1%. In the European Drysdale et al study, in healthy infants ≤12 months of age. RSV hospitalizations were significantly reduced by 83.3%.
What would be the NNT for my patient if I administer Nirsevimab?
Answer: Adjust the efficacy from the study (83%) based on my patient’s baseline risk (0.1% or 1 in 1,000) of experiencing an RSV hospitalization. This gives the Absolute Risk Reduction (ARR) for my patient= 0,083
Then, calculate the NNT by taking the inverse: 100/0,083=1.204,819 1204 that is NNT adjusted to my patient’s risk).
Is it justifiable for the mother or father that it would be necessary to administer the medication to 1204 patients like mine to prevent one hospitalization due to or associated with RSV?