Pre-reg

n
. EBM revision


Prepared by J . Durodie

S. Gammie (Today)
How good are your EBM skills?
You sit on your CCG Board and therefore have the
responsibility for deciding which of these four
programmes

for heart attack victims the CCG should
fund:

Programme A reduced the rate of deaths by 19%;


Programme B produced an absolute reduction in
deaths of 3%;


Programme C increased patients' survival rate from
84% to 87%;


Programme D meant that 33 people needed to enter the
programmeto avoid one death.


Which would you choose?

Programme C increased patients' survival rate from
84% to 87%

Programme B produced an absolute reduction in
deaths of 3%;

Death rates reduced from 16% to 13%,
ARR =16 - 13 =3%

Programme D meant that 33 people needed to enter the
programmeto avoid one death.

NNT =100 / ARR =100/3 =33

Programme A reduced the rate of deaths by 19%;

Death rates reduced from 16% to 13%,
RRR =(3 / 16) x 100 =18.75%



EXERCISE 1 Match the term with the
definition

RCT

Meta-analysis

Case Control study

Cohort study

Case Report

NNT

NNH

POO

DOO

Exercise 2 Critically Appraise a study
comparing new Drug A with older Drug Y

N Engl J Med 2001; 345: 494-502
EBM what is truth vs. hype?
Can you help your patients make sense of the CURE study in everyday
language that they can understand?
Marketed as:
20% benefit (risk
reduction) to patients;
1% risk increase
(harm);
N Engl J Med 2001; 345: 494-502
N Engl J Med 2001; 345: 494-502
N Engl J Med 2001; 345: 494-502
20% relative risk reduction
2.1% absolute risk reduction
NNT 48
38% relative risk increase
1% absolute risk increase
NNH 100
CURE study results - N Engl J Med 2001; 345: 494-502
use of patient
decision aid eg.
CURE study results - N Engl J Med 2001; 345: 494-502
use of patient
decision aid eg.
Results in better
informed, patient-
focussed decision
making
concordance &
waste