Additional links and pictures from USMLE Step I Epi/Biostats prep – Dr.

Kevin Schuller

Calculating incidence for multiple periods (2 months, 3 years, etc.)

Average method:

At risk population(beginning) + At risk population(end)

2 x # Periods

Half period method:

New cases of disease counted as a half period of observation. Sum all periods to
determine overall incidence rate.

Rework this question solving for different post-test probabilities by changing key elements (Sp, Sn,
prevalence) for practice

A 55 year-old male visits his primary care provider with a complaint of urinary infrequency.
Exam finds a 1 cm nodule on his prostate gland. The physician orders a prostate specific antigen
(PSA) serum test. By common standard, a PSA level greater than 4 ng/mL is considered
abnormal. Using this standard, the test has a sensitivity of 90% and a specificity of 80%. A
recently published epidemiological article found that in a cross-sectional study, 20% of men in
this age group have prostate cancer. The result of the patient’s PSA is 7 ng/mL. What is your
best estimate of the likelihood this man actually has prostate cancer?

Number needed to treat/harm (NNT/NNH)

NNT: Number of individuals that will need the intervention in order to prevent one new case of
the disease. It is calculated by taking the inverse of the absolute risk reduction (ARr). It is used
for prevention cohort studies.
NTT = 1/ARr
NNH: Number of individuals that will need to be exposed in order to cause one new case of the
disease. It is calculated by taking the inverse of the absolute risk (AR). It is used for exposure
cohort studies.
NNH = 1/AR

Superiority trial (drug vs. placebo) – Single tailed t test

H0: Drug ≤ Placebo

H1: Drug > Placebo

Non-inferiority trial (drug vs. standard of care) – Single tailed t test

H0: Drug < Standard of care

H1: Drug ≥ Standard of care