GRADE guidelines: 10. Considering resource use and rating the quality of economic evidence

Local Health Unit, Azienda USL Modena, Via S. Giovanni del Cantone 43 Modena, Modena 41100, Italy.
Journal of clinical epidemiology (Impact Factor: 3.42). 08/2012; 66(2). DOI: 10.1016/j.jclinepi.2012.04.012
Source: PubMed


In this article, we describe how to include considerations about resource utilization when making recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Study design and settings:
We focus on challenges with rating the confidence in effect estimates (quality of evidence) and incorporating resource use into evidence profiles and Summary of Findings (SoF) tables.

GRADE recommends that important differences in resource use between alternative management strategies should be included along with other important outcomes in the evidence profile and SoF table. Key steps in considering resources in making recommendations with GRADE are the identification of items of resource use that may differ between alternative management strategies and that are potentially important to decision makers, finding evidence for the differences in resource use, making judgments regarding confidence in effect estimates using the same criteria used for health outcomes, and valuing the resource use in terms of costs for the specific setting for which recommendations are being made.

With our framework, decision makers will have access to concise summaries of recommendations, including ratings of the quality of economic evidence, and better understand the implications for clinical decision making.

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    • "Studies were assessed using the methods recommended by the Campbell and Cochrane Economic Methods Group [13]. These include the methods outlined in the Cochrane handbook and more recent developments [14] [15], including methods to incorporate an economic perspective into the GRADE evidence system [16]. Current guidance from the CCEMG on quality assessment of cost-analyses is to use relevant components from one of two checklists: Jefferson et al. (1995) and Drummond et al. (2005) [17] [11]. "
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    • "The GRADE working group recommended the approach used to evaluate the quality of the evidence (Balshem et al., 2011; Guyatt et al., 2011a, b, c, d, e, f, g, h, 2013a, b, c; Andrews et al., 2013a, b; Brunetti et al., 2013). The GRADE system separates the process of grading scientific evidence to inform recommendations from the process of making recommendations. "
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    • "Most recently, methods guidelines have been published on the use of the GRADE system to rate quality of evidence for resource use and costs, which will facilitate the incorporation of economic evidence into Summary of Findings tables. These tables are increasingly used in Cochrane to summarise principal findings and quality of evidence for important outcomes [21]. "
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