需要治疗的数量:是时候优雅地鞠躬了
M Hassan Murad1, Yngve Falck-Ytter2, Neha Ramachandran3
1Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA; Evidence Foundation, Cleveland Heights, OH, USA.
Journal of clinical epidemiology
|August 9, 2025
概括
治疗所需人数 (NNT) 具有统计上的局限性,因此在卫生政策决策中不可靠. 它的置信区间很难解释,当结果没有统计学意义时.
科学领域:
- 生物统计学 生物统计学
- 卫生经济学 卫生经济学
- 临床流行病学 临床流行病学
背景情况:
- 治疗所需人数 (NNT) 是临床研究中广泛使用的绝对效果指标.
- 它的效用取决于观察到的风险差异的统计学意义.
研究的目的:
- 确定并详细阐述在决策环境中使用NNT的局限性.
- 建议在指导方针制定,政策决策和医疗技术评估中停止使用NNT.
主要方法:
- 对NNT的统计属性的概念分析.
- 检查NNT置信区间行为,当风险差异不是统计学上显著的.
- 评估NNT在平衡利益和危害方面的适用性.
主要成果:
- 当风险差异置信区间跨越零值时,NNT置信区间变得不连接,包括不可信的值.
- 在NNT尺度上,评估利益与危害之间的权衡更加复杂.
- 统计和方法的局限性阻碍了它在基于证据的决策中的有用性.
结论:
- 在关键决策过程中,NNT在统计和方法上有缺陷.
- 建议在指南制定,政策和卫生技术评估中放弃NNT.
- 应考虑替代绝对效应措施,以确保可靠的决策.
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