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16-September-2008 16:15:13 - risk reduction In epidemiology, the absolute risk reduction is the decrease in risk of a given activity or treatment in relation to a control activity or treatment. It is the inverse of the number needed to treat.1 For example, consider a hypothetical drug which reduces the risk of colon cancer by 50%. Even without the drug, colon cancer is fairly rare, maybe 1 in 3,000 in every 5 year period. The rate of colon cancer for a 5-year treatment with the drug is therefore 1/6,000, as by treating 6,000 people with the drug, one can expect to reduce the number of colon cancer cases from 2 to 1. In general, absolute risk reduction is usually computed with respect to two treatments A and B, with A typically a drug and B a placebo in our example above, A is a 5-year treatment with the hypothetical drug, and B is treatment with placebo, i.e. no treatment. A defined endpoint has to be specified in our example: the appearance of colon cancer in the 5 year period. If the probabilities pA and pB of this endpoint under treatments A and B, respectively, are known, then the absolute risk reduction is computed as pB-pA. The inverse of the absolute risk reduction, NNT, is an important measure in pharmacoeconomics. If a clinical endpoint is devastating enough e.g. death, heart attack, drugs with a low absolute risk reduction may still be indicated in particular situations. If the endpoint is minor, health insurers may decline to reimburse drugs with a low absolute risk reduction. Contents 1 Worked example 2 References 3 See also 4 External links Worked example Abbreviation Variable Equation Value - subjects in control group - 250 - subjects in experimental group - 150 - events in control group - 100 - events in experimental group - 15 CER control event rate = events / subjects in control group 0.4, or 40% EER experimental event rate = events / subjects in experimental group 0.1, or 10% ARR absolute risk reduction or increase = CER - EER 0.3, or 30% RRR relative risk reduction or increase = CER - EER / CER 0.75 NNT number needed to treat/number needed to harm = 1 / ARR 3.33 OR, RR odds ratio, relative risk not really identical, but similar -- see articles for details = CER / EER 4 References ^ Laupacis A, Sackett DL, Roberts RS. An assessment of clinically useful measures of the consequences of treatment. N Engl J Med 1988;318:1728-33. PMID 3374545. See also Absolute risk increase Number needed to harm External links Measures of effect size of an intervention - unmc.edu. Retrieved from http://en..org/wiki/Absolute_risk_reduction Categories: Epidemiology Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 18 March 2008, at 15:31
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