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JAMA Guide to Statistics and Methods
November 14, 2017

The “Utility” in Composite Outcome Measures: Measuring What Is Important to Patients

Author Affiliations
  • 1Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research/US Food and Drug Administration, Silver Spring, Maryland
JAMA. 2017;318(18):1820-1821. doi:10.1001/jama.2017.14001

There are many harmful manifestations of atherosclerotic cardiovascular disease (ASCVD). Because all of these manifestations are undesirable, combining the most important ones into a single study outcome measure can simplify efforts to measure the overall effect of the disease on health outcomes. For example, ASCVD can result in myocardial infarction (MI), stroke, or death. Each of these is to be avoided, and how well an intervention reduces the risk of any of these occurring can be measured by combining all of these clinical outcomes into a single composite end point. A composite end point is an outcome that is defined as occurring if 1 or more of the components occurs. For ASCVD, one of the most common composites is called major adverse cardiovascular events (MACE). Because a composite outcome occurs more frequently than its individual components, composites can reduce the number of study participants required to achieve the desired power of a study, making it easier and less expensive to conduct a clinical trial.