Portnoy J, Jones EM; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 3392.
Children's Mercy Hospital, Health Management, 2401 Gillham Road, Kansas City, MO 64108 Tel. (816) 234-3097 Fax (816) 346-1301
RESEARCH OBJECTIVE: Allergic rhinitis is one of the most common chronic conditions affecting adults and children. The challenge for physicians is to determine which treatments are most effective for individual patients using evidence from the medical literature. Evidence-Based Medicine (EBM) is the process of using that evidence to make clinical decisions. By using these metrics, a consistent and understandable estimate of the relative effectiveness of different treatments can be determined. STUDY DESIGN: Measures commonly used in EBM include treatment thresholds, number needed to treat (NNT), and number needed to harm (NNH). Since the NNT is the number of patients who need to be treated to benefit one additional person over placebo, lower numbers are better. An NNT of 1 to 5 is considered highly effective, 8 to 15 is moderately effective, and more than 20 is poorly effective. The NNH is similar except that larger numbers are better. The treatment threshold is determined as Rx=Harm/(Harm + Benefit) where benefit is 1/NNT and harm is 1/NNH.We determined treatment thresholds, NNT and NNH by performing a search of the medical literature for randomized placebo controlled trials of nonsedating antihistamines, intranasal corticosteroids, monteleukast, azelastine, allergen immunotherapy, and anti-IgE. This process was particularly difficult since few studies provide suffiicient information either to directly determine these values or even to estimate them. POPULATION STUDIED: PRINCIPAL FINDINGS: Though the individual agents differed from each other, as a class, the mean NNT for nonsedating antihistamines is 15.2, nasal corticosteroids is 4.4, and the NNT for monteleukast is 14.3, azelastine is 5.0, allergen immunotherapy is 4.6, and anti-IgE is 12.4. When combined with NNH and excluding consideration of nonphysiologic factors such as cost and convenience, we determined the following treatment thresholds: antihistamines - 23%, nasal corticosteroids - 8%, azelastine 16%, monteleukast 8%, anti-IgE 50% and immunotherapy 25%. CONCLUSIONS: When used appropriately, this information could become very useful for clinicians particularly if cost, convenience and other indirect factors can be factored into the analysis. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: We recommend that pharmaceutical manufacturers sponsor studies that provide this type of information and that this type of analysis be performed for other conditions that require medical decisions to be made.
Publication Types:
Keywords:
- Adrenal Cortex Hormones
- Adult
- Biomedical Research
- Child
- Chronic Disease
- Common Cold
- Decision Support Techniques
- Evidence-Based Medicine
- Histamine H1 Antagonists
- Histamine H1 Antagonists, Non-Sedating
- Humans
- Research Design
- Rhinitis
- Rhinitis, Allergic, Perennial
- Rhinitis, Allergic, Seasonal
- analysis
- methods
- therapy
- hsrmtgs
UI: 103622855
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