Numbers Needed To Treat

The Number Needed to Treat (NNT) is the number of patients you need to treat to prevent one additional bad outcome (e.g. myocardial infarction, stroke).¹ The NNT specifies the treatment, its duration, and the adverse outcome being prevented. Therefore if a drug has an NNT of 10, it means you have to treat 10 people with the drug to prevent one additional bad outcome.

• The NNT is the inverse of the Absolute Risk Reduction (ARR).²
• The ARR is the Control Event Rate (CER) minus the Experimental Event Rate (EER), or ARR = CER - EER.
• NNTs are always rounded up to the nearest whole number and accompanied by its 95% confidence interval.
• Example: if a drug reduces the risk of a bad outcome from 50% to 40%, the ARR = 0.5 - 0.4 = 0.1. Therefore the NNT = 1/ARR = 10.
• A nomogram can be used to find the NNT by using the proportion of events in the control group and the relative risk reduction.³

• NNTs can be used either for summarising the results of a therapeutic trial or for medical decision making about an individual patient.²
• The NNT provides a more clinically useful measure of the relative benefit of an active treatment over a control than the use of the relative risk, the relative risk reduction or the odds ratio.⁴
• Numbers needed to treat are sensitive to factors that change the baseline risk such as the outcome considered, patients' characteristics, secular trends in incidence and case fatality, and the clinical setting.⁵

• Although NNTs are easy to interpret, they cannot be used for performing a meta-analysis. Pooled numbers needed to treat derived from meta-analyses can be seriously misleading because the baseline risk often varies appreciably between the trials.⁵
• Applying the pooled relative risk reductions calculated from meta-analyses or individual trials to the baseline risk relevant to specific patient group produces a useful number needed to treat.⁵