Key result
Carvedilol increased average total years of life compared to metoprolol tartrate by 1.15 years (95% CI 0.64-1.66; P<0.0001), yielding a years-needed-to-treat of 9.2.
Why the study?
Does carvedilol improve life expectancy compared to metoprolol tartrate when assessed by the years-needed-to-treat metric?
Does carvedilol improve life expectancy compared to metoprolol tartrate when assessed by the years-needed-to-treat metric?
The years-needed-to-treat (YNT) metric may more accurately account for the long-term survival benefits of interventions in randomized trials compared to traditional numbers-needed-to-treat (NNT).
Answers are grounded in this paper and cite their sources.
May support carvedilol over metoprolol tartrate for HF survival in cohorts; leaves open randomized confirmation via YNT metric.
AIMS: A standard metric to estimate absolute treatment effects is numbers-needed-to-treat (NNT), which implicitly assumes that all benefits reverse at trial-end. However, in-trial survival benefits typically do not reverse until long after trial-end, so that NNT will substantially underestimate lifetime benefits. METHODS AND RESULTS: We developed a new concept, years-needed-to-treat (YNT) to add 1 year of life, that quantifies the expected average life expectancy for two treatments including the estimated years of life remaining post-trial. Numbers-needed-to-treat and YNT were calculated in the COMET trial, in which carvedilol vs. metoprolol tartrate resulted in 17% lower mortality over 4.8 years. A multivariate Cox model was used to predict survival. Remaining years of life were estimated using the mortality-life-table method. At trial-end, survival was 9% higher in the carvedilol arm. Assuming that patients remained on the same therapy post-trial, the average total years of life for carvedilol vs. metoprolol were 10.63 +/- 0.19 vs. 9.48 +/- 0.18 (P < 0.0001) or 1.15 (95% confidence interval 0.64-1.66) additional years of life. The YNT was 9.2, indicating that 9.2 person-years of treatment added 1 person-year of life, compared with NNT of 59. CONCLUSION: Compared with NNT, the YNT method more accurately accounts for potential long-term benefits of interventions in randomized trials.
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Levy et al. (2009) studied this question. Carvedilol vs. Metoprolol tartrate was evaluated on Average total years of life (MD 1.15, 95% CI 0.64-1.66, p=<0.0001). Carvedilol increased average total years of life compared to metoprolol tartrate by 1.15 years (95% CI 0.64-1.66; P<0.0001), yielding a years-needed-to-treat of 9.2.
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