The Search for Ron Dayne

Ron Dayne is an accomplished football player who, while playing for the University of Wisconsin, set an NCAA rushing record and won the Heisman Trophy in 1999.  He was drafted by the New York Giants in 2000, and last played for Houston Oilers in 2007.

For the past two years, I have been searching for Ron Dayne, not because of football, but because of a shared interest in NNT.  Perhaps someone with more Internet skills than I can put me in contact with him.

Ron Dayne’s particular interest in NNT centers on a concern for treating children with high cholesterol as expressed in the following letter to the Editor of the New York Times dated July 8, 2008.

I should be sleeping but instead I am left with insomnia at the thought of kids getting these meds on such flimsy evidence.

What does the data show for adults and cost-benefit?

From Dr. Sanghavi [the doctor quoted in the original New York Times article]: Bear with me for a little math. To determine a drug’s cost-benefit, we need to calculate something that epidemiologists call the “number needed to treat,” or NNT. Suppose an advertisement says a statin cuts the risk of a heart attack by 50 percent over five years. Sounds impressive, right? But if only two people in a group of 100 is expected to have a heart attack, then cutting the risk by 50 percent prevents only one heart attack in the group. In other words, the “number needed to treat” to prevent a heart attack is about 100.

Suppose an insurer is trying to figure out whether it should cover, say, Lipitor to prevent heart attacks, which costs (roughly) $5,000 per person over five years. If the NNT is 100, then an insurer pays $500,000 to prevent one heart attack. If the NNT is 50, then the insurer pays $250,000.

What's clear is that the higher the NNT — which is certainly the case for treating children with statins — the higher the costs. In children, the NNT could easily top 10,000 to prevent one heart attack, which means insurers could kick out tens of millions of dollars to prevent a single heart attack.

Of course, generic drugs would lower the price a lot. But keep in mind none of these estimates consider the costs of complications, blood tests to monitor liver function, repeated doctors visits, and other hidden costs.

If interested in NNTs and statins, you can read more here and here.

— Ron Dayne