PT  - JOURNAL ARTICLE
AU  - Brian S Alper
AU  - Peter Oettgen
AU  - Ilkka Kunnamo
AU  - Alfonso Iorio
AU  - Mohammed Toseef Ansari
AU  - M Hassan Murad
AU  - Joerg J Meerpohl
AU  - Amir Qaseem
AU  - Monica Hultcrantz
AU  - Holger J Schünemann
AU  - Gordon Guyatt
ED  - ,
TI  - Defining certainty of net benefit: a GRADE concept paper
AID  - 10.1136/bmjopen-2018-027445
DP  - 2019 Jun 01
TA  - BMJ Open
PG  - e027445
VI  - 9
IP  - 6
4099  - http://bmjopen.bmj.com/content/9/6/e027445.short
4100  - http://bmjopen.bmj.com/content/9/6/e027445.full
SO  - BMJ Open2019 Jun 01; 9
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.