Calculating cost per event avoided using a composite number needed to treat

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Pharmacoeconomics

Background:

• Number Needed to Treat (NNT) and Cost Per Event Avoided (CPEA) are standard metrics for evaluating chronic treatment value, typically based on primary trial endpoints.
• This conventional approach may underestimate a treatment's complete clinical and economic benefits by excluding outcomes beyond the primary endpoint.

Purpose of the Study:

• To develop composite NNTs and derive CPEA to estimate the comprehensive value of semaglutide and dulaglutide in patients with established cardiovascular disease.
• To highlight the limitations of primary endpoint-focused NNT/CPEA calculations and advocate for broader outcome measures.

Main Methods:

• Utilized data from two cardiovascular outcomes trials: SELECT (semaglutide) and REWIND (dulaglutide).
• Calculated NNT and CPEA using composite endpoints including 3-point major adverse cardiovascular events (MACE-3), 5-point MACE (MACE-5), and cardiovascular-kidney-metabolic (CKM) events.

Main Results:

• NNT decreased with broader composite endpoints: NNT_CKM was 8 for semaglutide and 23 for dulaglutide, compared to NNT_MACE-3 of 67 and 72, respectively.
• CPEA also decreased with composite endpoints: CPEA for CKM events was $190,387 for semaglutide and $607,886 for dulaglutide, significantly lower than for MACE-3.

Conclusions:

• NNT and CPEA calculations based solely on primary endpoints do not capture the total value of treatments like semaglutide and dulaglutide.
• Employing composite endpoints that encompass a wider range of benefits provides a more accurate assessment of treatment value and cost-effectiveness.