Costs of Additional Treatment Success (COATS) Based on Numbers Needed to Treat (NNT) is a Simplified Calculation Method to Facilitate Physicians Medical Decisions with Regards to Monetary Costs

Abstract

Aims: Due to limited resources, to provide a simple and transparent tool for physicians to facilitate budget-related, medical decisions in any patient. Study Design: Comparative study. Methodology: Several articles with topics referring to the 2008 ”Surviving Sepsis Campaign” guidelines in critically ill patients with varying effects on defined clinical endpoints were analyzed regarding the costs of additional treatment success (COATS). A simplified ICER = incremental cost-effectiveness ratio to assess COATS was expressed as the product of the number of patients needed to treat (NNT) and the difference in treatment costs per patient. Results: In publications with significant treatment effects enabling calculation of NNTs, calculating “COATS = NNT x delta costs per patient", mean costs to avoid one additional death or morbidity could be defined. Considering the 95% confidence interval, estimated costs at minimum and maximum to reach distinct clinical endpoints could be expressed. In studies with no significant results, NNTs and COATS were tending to infinity. Conclusion: COATS based on NNT as a simplified ICER is an easy way for the physician at the bedside caring for individual patients to explicitly describe the amount of money which has to be spent to reach definable aims in the clinical setting in one additional patient, such as reduction of mortality or morbidity, or to reassess therapies without significant results. In contrast to COATS, ICER based on quality-adjusted life years may be necessary to perform calculation of the short-term and long-term costs for the community and the adequate allocation of health care resources.