Numbers needed to treat with home palliative care for one additional person to die at home in populations with different cancer home death rates
Extracted and adapted from / reference as: Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Effectiveness and cost-effectiveness of home palliative
care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD007760. DOI:
10.1002/14651858.CD007760.pub2. Access at the Cochrane Library
Assumed
control
risk (ACR)
Study
population
control
risk
Description
-
307 home deaths per 1,000 cancer deaths
Numbers needed to treat
to benefit
(NNTB) (95% CI)
5
(3 to 14)
Interpretation and application to local numbers of cancer deaths
- For one additional patient to die at home five more would need to
receive home palliative care as opposed to usual care
9
(5 to 26)
- For one additional patient to die at home nine more would need to
receive home palliative care as opposed to usual care
i.e. home death rate across the control groups of the
seven trials included in the meta-analysis
Low home
death
population
ACR
- 128 home deaths per 1,000 cancer deaths
Medium
home
death
population
ACR
-
High
home
death
population
ACR
- 454 home deaths per 1,000 cancer deaths
e.g. Norway in 2003 (1,373 cancer deaths happened at
1
home in a total of 10,723 cancer deaths)
278 home deaths per 1,000 cancer deaths
Applying this NNTB to the numbers of deaths, if all the people dying
from cancer received home palliative care, there would be more 1,191
home deaths and consequently the home death rate would rise to 239
home deaths per 1,000 cancer deaths (i.e. 2,564 cancer deaths at
home in a total of 10,723 cancer deaths)
6
(3 to 15)
- For one additional patient to die at home six more would need to
receive home palliative care as opposed to usual care
5
(3 to 13)
- For one additional patient to die at home five more would need to
receive home palliative care as opposed to usual care
i.e. mean home death rate across six European countries
in 2002/2003 – Belgium, Italy, the Netherlands, Norway,
1
England, and Wales
e.g. the Netherlands in 2003 (18,100 cancer deaths
1
happened at home of a total of 39,867 cancer deaths)
Applying this NNTB to the numbers of deaths, if all the people dying
from cancer received home palliative care, there would be more 7,973
home deaths and consequently the home death rate would rise to 654
home deaths per 1,000 cancer deaths (i.e. 26,073 cancer deaths at
home in a total of 39,867 cancer deaths)
Adapted from summary of findings for the main comparison in / reference as Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Effectiveness and cost-effectiveness of home palliative care services for adults
with advanced illness and their caregivers. Cochrane Database of Systematic Reviews 2013, Issue 6, Art. No.: CD007760. DOI: 10.1002/14651858.CD007760.pub2.
Numbers need to treat to benefit (NNTB) were calculated for the study population control risk and for three other assumed control risks (ACRs). These were based on recent cancer home death rates from a whole
population study across six European countries.6 1) low home death population assumed the lowest rate of 128 deaths at home per 1000 cancer deaths (Norway); 2) medium home death population assumed the mean
across the six European countries (278 deaths at home per 1000 cancer deaths; 3) high home death population assumed the highest rate of 454 deaths at home per 1000 cancer deaths (the Netherlands). We applied
rates related to cancer as the included studies involved largely cancer patients.
How to calculate NNTB for other regions: an example with England & Wales
Mortality statistics
2
41,040 cancer deaths happened at home in a total of 143,181 cancer deaths in 2011, i.e. 287 home deaths per 1,000 cancer deaths.
Computation of NNTB from the odds ratio (OR) of the meta-analysis
The computation proceeds as follows:
3
OR (odds ratio) = 2.21 (comparison of home deaths: home palliative care vs. usual care)
ACR (assumed control risk) = 0.287 (home death rate in E&W 2011, see mortality statistics above)
The NNTB is 5:
NNTB =
__
0.287 –
1 _
__
__ 2.21 x 0.287 _
1 – 0.287 + 2.21 x 0.287
=
__
0.287 –
1
_ 0.634 _
=
1
= 5.435
| 0.287 – 0.471 |
1 – 0.287 + 0.634
Interpretation and application to local numbers of cancer deaths
For one additional patient to die at home five more would need to receive home palliative care as opposed to usual care.
Applying this NNTB to the numbers of deaths, if all the people dying from cancer received home palliative care, there would be more 28,636 home deaths and
consequently the home death rate would rise to 486 home deaths per 1,000 cancer deaths (i.e. 69,636 cancer deaths at home in a total of 143,181 cancer
deaths)
References:
1. Cohen J, Houttekier D, Onwuteaka-Philipsen B, Miccinesi G, Addington-Hall J, Kaasa S, Bilsen J, Deliens L. Which patients with cancer die at home? A study of six
European countries using death certificate data. Journal of Clinical Oncology 2010; 28(13):2267-73.
2. Office for National Statistics. Deaths registered in England and Wales (Series DR, 2011). Newport: Crown, 2012. Available from
www.ons.gov.uk/ons/taxonomy/index.html?nscl=Death+Registrations.
3. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.
Available from www.cochrane-handbook.org.