1. Defining certainty of net benefit: a GRADE concept paper
- Author
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Ilkka Kunnamo, Peter Oettgen, Alfonso Iorio, Mohammed T. Ansari, M. Hassan Murad, Brian S. Alper, Joerg J Meerpohl, Amir Qaseem, Holger J. Schünemann, Gordon H. Guyatt, and Monica Hultcrantz
- Subjects
media_common.quotation_subject ,Concept Formation ,Decision Making ,030204 cardiovascular system & hematology ,clinical decision making ,03 medical and health sciences ,0302 clinical medicine ,Clinical decision making ,Medicine ,Humans ,Guideline development ,030212 general & internal medicine ,Grading (education) ,media_common ,decision analysis ,Actuarial science ,business.industry ,Communication ,evidence synthesis ,General Medicine ,Evidence-based medicine ,Certainty ,Harm ,Evidence Based Practice ,Practice Guidelines as Topic ,Public Health ,business ,evidence-based medicine ,guideline development ,Evidence synthesis ,Decision analysis - Abstract
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.
- Published
- 2019