Calculating cost per event avoided using a composite number needed to treat.
The study highlights that using composite endpoints can provide a more comprehensive understanding of the value of treatments like dulaglutide, with NNTs of 72 for MACE-3 and CPEA of $1,884,013.
Where it sits
this study against the rest of the dulaglutide corpusSummary and findings
This study calculated the number needed to treat (NNT) and cost per event avoided (CPEA) for dulaglutide and semaglutide in patients with established cardiovascular disease. The NNT for dulaglutide was reported as 72 for 3-point major adverse cardiovascular events (MACE-3) and 23 for cardiovascular-kidney-metabolic events (CKM). The CPEA for dulaglutide was $1,884,013 for MACE-3 and $607,886 for CKM.
Abstract
<h4>Objective</h4>Number needed to treat (NNT) and cost per event avoided (CPEA) are measures used to represent the clinical and economic value of chronic treatments and are commonly calculated based on primary endpoints from trials. This approach, although widely used, does not reflect the complete value of a treatment, as it does not consider outcomes beyond the primary endpoints. This research aims to overcome this limitation by developing multiple composite NNTs to derive the CPEA to estimate a total value of semaglutide and dulaglutide in people with established cardiovascular disease.<h4>Methods</h4>Two cardiovascular outcomes trials were selected, SELECT (NCT03574597, semaglutide 2.4 mg) and REWIND (NCT01394952, dulaglutide 1.5 mg). NNT was calculated as NNT = 1/ARR where ARR = control event rate - experimental event rate. NNT was estimated for 3-point major adverse cardiovascular events (MACE-3; primary endpoint of the trials), 5-point MACE (MACE-5), and cardiovascular-kidney-metabolic events (CKM). CPEA of MACE-3, MACE-5, and CKM was calculated as NNT*duration of mean follow-up (semaglutide) or duration of median follow-up (dulaglutide)*estimated net price.<h4>Results</h4>The NNT decreased as the number of outcomes in the composite endpoint increased, where NNT<sub>MACE-3</sub>, NNT<sub>MACE-5</sub>, and NNT<sub>CKM</sub> were 67, 49, and 8 for semaglutide, and 72, 64, and 23 for dulaglutide, respectively. Similarly, the CPEA decreased as the number of outcomes in the composite endpoint increased, where the CPEA for MACE-3, MACE-5 and CKM calculations were $1,662,001, $1,232,417, and $190,387 for semaglutide and $1,884,013, $1,670,366, and $607,886 for dulaglutide.<h4>Conclusions</h4>This research illustrates the limitations of using a NNT focused only on the primary endpoint, as it does not capture the total benefit of the treatment. When considering the value of treatments through NNT or CPEA analyses, a composite endpoint capturing broader benefit should be utilized.
Background
This paper addresses the clinical and economic evaluation of chronic treatments for cardiovascular disease, specifically focusing on the utility of number needed to treat (NNT) and cost per event avoided (CPEA). Previous studies have primarily focused on primary endpoints, potentially overlooking the broader benefits of treatments. This research aims to provide a more comprehensive assessment by calculating composite NNTs and CPEA for dulaglutide and semaglutide.
Methods
The study utilized data from two cardiovascular outcomes trials: SELECT (semaglutide 2.4 mg) and REWIND (dulaglutide 1.5 mg). NNT was calculated using the formula NNT = 1/ARR, where ARR is the absolute risk reduction. The analysis focused on three composite endpoints: 3-point major adverse cardiovascular events (MACE-3), 5-point MACE (MACE-5), and cardiovascular-kidney-metabolic events (CKM).
Results
The NNT for dulaglutide was reported as 72 for MACE-3, 64 for MACE-5, and 23 for CKM. The corresponding CPEA values were $1,884,013 for MACE-3, $1,670,366 for MACE-5, and $607,886 for CKM. For semaglutide, the NNT values were 67 for MACE-3, 49 for MACE-5, and 8 for CKM, with CPEA values of $1,662,001 for MACE-3, $1,232,417 for MACE-5, and $190,387 for CKM.
Interpretation
The findings suggest that as the number of outcomes in composite endpoints increases, both NNT and CPEA decrease, indicating a potential broader benefit of treatments. However, while the NNT values are statistically significant, the clinical significance of these findings may vary, particularly given the high costs associated with the CPEA. Limitations include reliance on composite endpoints and the absence of direct clinical outcomes, which may affect the generalizability of the results.
Key findings
- NNT for dulaglutide MACE-3 was 72, MACE-5 was 64, and CKM was 23.
- CPEA for dulaglutide MACE-3 was $1,884,013, MACE-5 was $1,670,366, and CKM was $607,886.
- NNT for semaglutide MACE-3 was 67, MACE-5 was 49, and CKM was 8.
- CPEA for semaglutide MACE-3 was $1,662,001, MACE-5 was $1,232,417, and CKM was $190,387.
Limitations
- Based on composite endpoints, which may not reflect individual patient outcomes.
- Analysis derived from data of cardiovascular outcomes trials.
- No direct clinical outcomes reported.
- Potential for confounding due to reliance on secondary analyses.