TY - JOUR
T1 - Defining certainty of net benefit
T2 - A GRADE concept paper
AU - Alper, Brian S.
AU - Oettgen, Peter
AU - Kunnamo, Ilkka
AU - Iorio, Alfonso
AU - Ansari, Mohammed Toseef
AU - Murad, M. Hassan
AU - Meerpohl, Joerg J.
AU - Qaseem, Amir
AU - Hultcrantz, Monica
AU - Schünemann, Holger J.
AU - Guyatt, Gordon
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is used to assess and report certainty of evidence and strength of recommendations. This GRADE concept article is not GRADE guidance but introduces certainty of net benefit, defined as the certainty that the balance between desirable and undesirable health effects is favourable. Determining certainty of net benefit requires considering certainty of effect estimates, the expected importance of outcomes and variability in importance, and the interaction of these concepts. Certainty of net harm is the certainty that the net effect is unfavourable. Guideline panels using or testing this approach might limit strong recommendations to actions with a high certainty of net benefit or against actions with a moderate or high certainty of net harm. Recommendations may differ in direction or strength from that suggested by the certainty of net benefit or harm when influenced by cost, equity, acceptability or feasibility.
AB - Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is used to assess and report certainty of evidence and strength of recommendations. This GRADE concept article is not GRADE guidance but introduces certainty of net benefit, defined as the certainty that the balance between desirable and undesirable health effects is favourable. Determining certainty of net benefit requires considering certainty of effect estimates, the expected importance of outcomes and variability in importance, and the interaction of these concepts. Certainty of net harm is the certainty that the net effect is unfavourable. Guideline panels using or testing this approach might limit strong recommendations to actions with a high certainty of net benefit or against actions with a moderate or high certainty of net harm. Recommendations may differ in direction or strength from that suggested by the certainty of net benefit or harm when influenced by cost, equity, acceptability or feasibility.
KW - clinical decision making
KW - decision analysis
KW - evidence synthesis
KW - evidence-based medicine
KW - guideline development
UR - http://www.scopus.com/inward/record.url?scp=85067065448&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85067065448&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2018-027445
DO - 10.1136/bmjopen-2018-027445
M3 - Article
C2 - 31167868
AN - SCOPUS:85067065448
SN - 2044-6055
VL - 9
JO - BMJ open
JF - BMJ open
IS - 6
M1 - e027445
ER -