RT Journal Article
SR Electronic
T1 Defining certainty of net benefit: a GRADE concept paper
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e027445
DO 10.1136/bmjopen-2018-027445
VO 9
IS 6
A1 Alper, Brian S
A1 Oettgen, Peter
A1 Kunnamo, Ilkka
A1 Iorio, Alfonso
A1 Ansari, Mohammed Toseef
A1 Murad, M Hassan
A1 Meerpohl, Joerg J
A1 Qaseem, Amir
A1 Hultcrantz, Monica
A1 Schünemann, Holger J
A1 Guyatt, Gordon
A1 
YR 2019
UL http://bmjopen.bmj.com/content/9/6/e027445.abstract
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.