Table 1 Criteria for Evidence to Decision (EtD) frameworks for five different types of decisions
From: The GRADE Evidence to Decision (EtD) framework for health system and public health decisions
Clinical recommendations – individual perspective | Clinical recommendations – population perspective | Coverage decisions | Health system and public health recommendations | Diagnostic, screening and other tests (clinical and public health recommendations – individual and population perspective) | |
|---|---|---|---|---|---|
Priority of the problem | Is the problem a priority? | ||||
Test accuracy | Not applicable | How accurate is the test? | |||
Benefits & harms | How substantial are the desirable anticipated effects? | ||||
How substantial are the undesirable anticipated effects? | |||||
Certainty of the evidence | What is the overall certainty of the evidence of effects? | What is the certainty of the evidence of test accuracy? What is the certainty of the evidence for any critical or important direct benefits, adverse effects or burden of the test? What is the certainty of the evidence of effects of the management that is guided by the test results? How certain is the link between test results and management decisions? What is the overall certainty of the evidence of effects of the test? | |||
Outcome importance | Is there important uncertainty about or variability in how much people value the main outcomes? | Is there important uncertainty about or variability in how much people value the main outcomes? | Is there important uncertainty about how much people value the main outcomes? | Is there important uncertainty about or variability in how much people value the main outcomes? | Is there important uncertainty about or variability in how much people value the main outcomes, including adverse effects and burden of the test and downstream outcomes of clinical management that is guided by the test results? |
Balance | Does the balance between desirable and undesirable effects favour the intervention or the comparison? | Does the balance between desirable and undesirable effects favour the test or the comparison? | |||
Resource use | How large are the resource requirements (costs)? | ||||
What is the certainty of the evidence of resource requirements (costs)? | |||||
Does the cost-effectiveness of the intervention (the out-of-pocket cost relative to the net benefits) favour the intervention or the comparison? | Does the cost-effectiveness of the intervention favour the intervention or the comparison? | Does the cost-effectiveness of the intervention favour the intervention or the comparison? | Does the cost-effectiveness of the intervention favour the option or the comparison? | Does the cost-effectiveness of the test favour the test or the comparison? | |
Equity | What would be the impact on health equity? | ||||
Acceptability | Is the intervention acceptable to patients, their caregivers and healthcare providers? | Is the intervention acceptable to key stakeholders? | Is the intervention acceptable to key stakeholders? | Is the option acceptable to key stakeholders? | Is the test acceptable to key stakeholders? |
Feasibility | Is the intervention feasible for patients, their caregivers and healthcare providers? | Is the intervention feasible to implement? | Is the intervention feasible to implement? | Is the option feasible to implement? | Is the test feasible to implement? |