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Table 3 Summary of main features in GRADE, NICE DAP and the NHMRC systems for moving from evidence to making recommendations

From: Guidelines for guideline developers: a systematic review of grading systems for medical tests

  GRADE NHMRC system NICE DAP system
Evidence on accuracy Using a considered judgment process, derive presumed PIO for the four accuracy groups: TP, TN. FP, FN Evidence base aspects considered: Diagnostic accuracy aspects considered:
  - Validity
- Number of studies - Inclusiveness of underlying data
- Level of evidence - Meta analysis techniques
- Risk of bias - Cut off points
  - Uncertainty of data
Factors considered when moving to recommendations Then consider:   -
- Quality of evidence gathered Clinical impact: not explicitly explained Clinical effectiveness:
- Patient’s values and preferences Generalisibility: how well does the body of evidence match the the body of evidence match thepopulation and clinical setting being targeted by the guideline - Nature and quality of evidence derived from expert,
- Costs Applicability: is the evidence body relevant to the Australian healthcare context and culture - Lay members and stakeholder judgments
- Benefits vs harms Evidence base: - Uncertainty of evidence and differences in evidence gathered under research conditions vs in actual
  - Number of studies - Clinical practice
  - Level of evidence - Greater benefits or harms in subgroups
  - Risk of bias - Risks and /or benefits of technology from patients perspective
    - Position of technology in overall care pathway and available alternative treatments
   Consistency: not explicitly explained Cost Effectiveness:
    - Impact on patient outcomes
    - Robustness and appropriateness of model
    - Plausibility of inputs and assumptions made in economic model
    - Evaluation of the modeling approach and related evidence effectiveness ratios (ICERs) generated by the models
    - Range and plausibility of the incremental cost-
    - Likelihood of decision error and consequences
    - Degree of clinical need of patients under consideration
    - Potential for long term benefits of innovation