Abstract
Objective: To assess the utility of number needed to treat (NNT) as a tool for cost effectiveness analysis.
 Methods: Two monoclonal antibodies (MAbs), used for induction therapy viz basiliximab and daclizumab in renal transplantation, were identified. Pivotal placebo controlled clinical trials, mentioned in the innovator package inserts, were compared and analyzed for acute graft rejection and graft survival at 12 mo. NNT viz-a-vis cost was calculated and compared.
 Results: Daclizumab was comparable to basiliximab for acute graft rejection (NNT 10 vs. 9) but better for graft survival (20 vs. 25) at 12 mo, when used along with triple drug regimen (cyclosporine, azathioprine and corticosteroid). However, considering the cost of regimen for these drugs, in terms of NNT, basiliximab was more cost effective (INR 12,52,044 vs. 28,70,400 for acute rejection and INR 34,77,900 vs. 57,40,800 for graft survival). On the other hand, when these MAbs were used along with dual drug regimen (cyclosporine and corticosteroid), daclizumab was more cost effective for graft survival at 12 mo. The higher cost of daclizumab regimen (INR 2,87,040 vs. 1,39,116 for basiliximab) was offset by its substantially lower NNT (20 vs. 58-75 for one extra graft survival at 12 mo).
 Conclusion: This study demonstrates the utility of NNT in ascertaining relative effectiveness of treatment modalities that would help to formulate appropriate healthcare policies.
Highlights
World Trade Organization recognizes rational selection and use of medicines as one of the underpinning elements for access to medicines [1]
The annual rate of renal transplantation in India is 3.25/million population/year, which is far low when compared to the prevalence of end-stage renal disease (ESRD) patients i.e., 150/million population/year
In study 1 (B-CAS), the incidence of rejection in basiliximab arm and placebo arm meant that basiliximab led to an absolute risk reduction (ARR) of 11%
Summary
World Trade Organization recognizes rational selection and use of medicines as one of the underpinning elements for access to medicines [1]. Reports show that nearly 50-80% Indian population is not able to access all the medicines that they need as 21.9% population is below poverty line and 60% of the total healthcare expenditure is out of pocket by patients themselves [2,3,4]. India approves drugs on the basis of a drug’s benefit-risk analysis and uses price capping of essential and certain other medicines. This becomes more significant in light of healthcare infrastructure in India and financial wherewithal of the population. Lack of such pharmacoeconomic consideration increases health care cost but the overall disease burden as well. The awareness regarding principles of pharmacoeconomics is scarce amongst medical professionals and needs to be augmented [9]
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