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The number needed to treat (NNT) is a simple-to-understand absolute effect measure. However, it is only sensible when the risk difference is statistically significant. We highlight two important limitations of using NNT in the context of decision-making (developing a guideline, a policy decision, or a health technology assessment). The first limitation of NNT relates to difficulties in expressing and interpreting the confidence interval (CI) for the NNT when the CI of the risk difference includes the null (ie, the results are not statistically significant). This CI of NNT will be disjointed and will include implausible values. The second limitation of NNT relates to the increased complexity of trading off benefits and harms on the NNT scale. This proposal calls for abandoning the use of NNT from decision-making contexts. The number needed to treat (NNT) has statistical and methodological limitations that make it unhelpful in the context of developing clinical practice guidelines and policy decisions. •The number needed to treat (NNT) is a simple-to-understand absolute effect measure.•When results are nonsignificant, the confidence interval of NNT includes infinity.•Making decisions based on multiple outcomes is complicated with NNTs.•Due to several limitations, we propose abandoning NNT from decision-making contexts.