Communicating treatment effectiveness in the context of chronic disease processes

Abstract

A better understanding of the risk concept in relation to treatment of chronic disease processes is warranted. Consequences of therapies may be described in terms of risk reductions or postponement of adverse outcomes. This review argues that for most interventions, neither of these measures adequately characterize the distribution of treatment benefit across patients. More focus should be placed on choosing the context-relevant outcome measure and on developing techniques for extracting and communicating 2D outcome measures where the distribution of outcomes across patients is explicitly reflected. Since the distribution of outcomes affects patients’ valuation of interventions, more research into risk communication is likely to lead to improved decision making.

Keywords::

• analysis
• chronic diseases
• cost–effectiveness
• expected utility theory
• numbers needed to treat
• risk communication
• survival curves

Disclosure

The authors have had no interaction with the manufacturer of trandolapril, which was used as an example for illustrative purposes. However, we are indebted to Pernille Buch and other TRACE investigators who provided us with long-term data on trandolapril.