Guidelines to understand and compute the number needed to treat

• Published in: BMJ mental health 2021-11, Vol.24 (4), p.131-136
• Main Authors: Vancak, Valentin, Goldberg, Yair, Levine, Stephen Z
• Format: Article
• Language: English
• Subjects: Clinical trials; Evidence-based medicine; Humans; Numbers Needed To Treat; Probability; Randomized Controlled Trials as Topic; Schizophrenia; schizophrenia & psychotic disorders; Schizophrenia - drug therapy; Statistics in Practice; Success; Survival analysis; Variables
• ISSN: 1362-0347; 1468-960X; 2755-9734
• DOI: 10.1136/ebmental-2020-300232

ObjectiveWe aim to explain the unadjusted, adjusted and marginal number needed to treat (NNT) and provide software for clinicians to compute them.MethodsThe NNT is an efficacy index that is commonly used in randomised clinical trials. The NNT is the average number of patients needed to treat to obtain one successful outcome (ie, response) due to treatment. We developed the nntcalc R package for desktop use and extended it to a user-friendly web application. We provided users with a user-friendly step-by-step guide. The application calculates the NNT for various models with and without explanatory variables. The implemented models for the adjusted NNT are linear regression and analysis of variance (ANOVA), logistic regression, Kaplan-Meier and Cox regression. If no explanatory variables are available, one can compute the unadjusted Laupacis et al’s NNT, Kraemer and Kupfer’s NNT and the Furukawa and Leucht’s NNT. All NNT estimators are computed with their associated appropriate 95% confidence intervals. All calculations are in R and are replicable.ResultsThe application provides the user with an easy-to-use web application to compute the NNT in different settings and models. We illustrate the use of the application from examples in schizophrenia research based on the Positive and Negative Syndrome Scale. The application is available from https://nntcalc.iem.technion.ac.il. The output is given in a journal compatible text format, which users can copy and paste or download in a comma-separated values format.ConclusionThis application will help researchers and clinicians assess the efficacy of treatment and consequently improve the quality and accuracy of decisions.