York College

The City University of New York Department of Health Professions

HPHS 201

Class Exercise

  1. Consider the following formulas:
    1. Number Needed to Treat (NNT) is the number of patients who have to receive the intervention to prevent one adverse outcome.
      1. NNT = 1/ARR
      2. (or 100/ARR, if ARR is expressed as a percentage instead of a fraction)
    2. Absolute Risk Reduction (ARR) is the difference between the EER and the CER.
      1. ARR = EER-CER
      2. (Note that “difference” is not the same as subtracting CER from EER. For example if the EER is 1.5 and the CER is 2.0, the difference is .5, not -.5)
    3. Cost of Preventing an Event (COPE).
      1. COPE = NNT x number of years treated x 365 days x the daily cost of the treatment

Problem #1:

A Merck representative visits your office and tells you that Fosamax® (alendronate) will decrease the incidence of repeat hip fracture by 50% over 3 years. That excites you because you have 20 elderly women and 5 elderly men who already have fractured one hip in your practice. You locate the study by Black in Lancet (1996) and find out that fracture occurs in 2.2% of placebo patients and 1.1% of patients on alendronate (Fosamax®).

  1. Calculate the NNT. Do not worry about a negative or minus sign result. Example: 1.1-2.2 = 1.1 and not -1.1 when calculating the NNT.
  2. Go to Epocrates Online and determine the cost of Fosamax®, based on one 70mg pill taken orally each week. (Keep in mind that generic Fosamax®, alendronate is now available, so calculate the COPE for both). Also, be aware that Fosamax is available in multiple doses for different routes. Show your actual calculation/math so we can tell what you did right versus wrong.
  3. What does it cost to prevent one hip fracture over 3 years, using the COPE calculation posted in the chapter?
  4. Is this more meaningful than just talking about a 50% reduction in hip fractures?
  5. FRAX www.shef.ac.uk/frax/ calculates the 10 year risk of a fracture in men and women based on bone mineral density (BMD). Try plugging in some information and see what the risk is. Example: woman, aged 65, weighs 110, height 5’4″, previous fracture, a smoker and drinker. The machine used was Hologic and her bone mineral density result was .5 gm/cm2. Now calculate the 10 year risk.
    1. What did you get?
    2. Take a snapshot of the result and include it in the lab report.
    3. Can you see how a large organization might use EBM, a calculator and drug costs to decide on the best therapy?
    4. Could this be automatically calculated with an EHR?
  6. Download the attached lab registry excel file. This registry was created from asthmatic patients at a local hospital with the patient identifiers removed, except for age. The scenario is: you are the asthma clinical champion at this same hospital.
  7. How would you take advantage of this data?
  8. First, take a look at an asthma clinical practice guideline (CPG) attached to the lab. Note that it is concise and easy to read.
  9. Understand that if an asthmatic was in the emergency room that implies they are no longer under control. Look at the CPG and it tells you inhaled corticosteroids (ICSs) are the mainstay of asthma management.
  10. Next, look at the Asthma Medicine Chart https://pq.lung.ca/wp-content/uploads/2017/06/Poster-Asthma-medications-chart.pdf for a list of common inhaled corticosteroids. Here are a few ideas, and I want to hear about any others you have:
  11. Sort asthmatics by age. How many are younger than 18?
  12. What percentage of all asthmatics are younger than 18?
  13. What percentage of all asthmatics have visited the emergency room (ER)? These might be your most severe OR least compliant.
  14. What percentage of all asthmatics are seen more frequently in the clinic (frequent flyers) than in ER, according to the spreadsheet?
  15. Are patients visiting clinic more frequently are on more medications than patients visiting ER (which might mean they are more severe or more compliant)?
  16. What percentage of patients that visited the emergency room (ER) were on inhaled corticosteroids (ICS)?
  17. Go to https://www.nlm.nih.gov/oet/ed/pubmed/pubmed_in_ebp/index.html
    1. This page contains PubMed Online Training
    2. Plug in scenario practice exercise into PICO https://pubmedhh.nlm.nih.gov/nlmd/pico/piconew.php following the steps to filter the final result
    3. Take a snapshot of the final filtered PubMed search results.
    4. Take a snapshot of the clinical queries search results and submit it as part of your lab report for the day.

Total questions to be answered: 17, 14 are written answers, 3 are images

Mark question #s/letters you are answering clearly for full credit.