Archive for August, 2012

Number needed to treat


Good Outcome Bad Outcome
control 55 233
experimental 36 252
Calculated results
80.90 percent of control subjects had the adverse outcome.

87.50 percent of experimental subjects had the adverse outcome.

The difference, the absolute risk increase, is 6.60 percent.

The 95% confidence interval for this difference ranges from 0.66% to 12.53% .

The NNH (Number Needed to Harm) is 16 . This means that about one in every 16 patients will be harmed by the treatment.

The 95% confidence interval for the NNT ranges from 8.0 to 150.5

EBHM


EBHC
1. OR: Odd Ratio: Angka yang menunjukan factor resiko terjadinya suatu outcome pada case control
2. RR: odds ratio pada cohort
3. Number needed to treat: menunjukan kefektifan/kemajuran
4. Number Needed to harm: menunjukan efek samping
NNH 1 : dari 5 hanya 1 yang punya efek samping
NNH 5 : dari 4 ada 4 yang punya efek samping
Contoh : Cohort
Wanita Umur <25 tahun kematian 65 tahun
<25 tahun (120 orang): 25 th ( 50 orang)
>25 tahun (150 orang) : 65 th (80 orang)

Exposure A; 70 B: 50
Control C:70 D:80

RR=(a/(a+b))/(c/c+d))
OR=RR wanita yang menikah <25 th memiliki resiko meninggal <65 th 1,25%
Klo RR 0,75% maka resiko wanita meninggal berkurang 25%
ARR = CER – EER
CER= 70/150 X100%
EER = 70/120 x 100%
RRR==CER-EER/OR
Pasien 288: Ctrimox 36 orang; control : 55 orang
Exposure A:36 B: 252
Control C:55 D:233
CER: (233/288) x100%= 81%
EER: (252/288) x100%=87,5%
ARR=CEE-EER= 87,5%-81%= 6,5%
RRR= (55-36)/288= 19/288= 0,07
NNT= 1/19= 0,05
Level Jurnal
Level 1. Trial Clinic Randomzied double bind dg jumlah sample besar (Multicenter double bind clinical trial), meta analisis
Level 2. RCT jumlah samplenya kecil/sedikit,, non RCT
Level 3. Cohort prospective
Level 4. Case control / seri laporan kasus
Level 5. Studi Animal, In vitro, pendapat dan opini ahli.
Primer:= cohort, case control, trial clinic
Sekunder: meta analisis
Tersier: Review
Referensi jurnal:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412701/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC80458
http://pediatrics.aappublications.org/content/114/4/e469.long
Perhitungan:
http://www.cebm.net/index.aspx?o=1160
http://www.medicine.ox.ac.uk/bandolier/band50/b50-8.html
http://www.graphpad.com/quickcalcs/NNT1.cfm