6 Putting it all together: from net effect estimate to the certainty of net benefit

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An evidence-based approach to clinical practice guidelines includes expressing the confidence that the desirable consequences outweigh the undesirable consequences for a particular recommendation. This is often done by expressing the strength of recommendation and the quality of evidence. The overall quality of evidence rating however is not the same thing as the confidence in the evidence that the summation of beneficial effects outweighs the summation of harmful effects. The objective of this year’s workshop is to extend the concepts of last year’s well-received workshop on determination of the net effect estimate and review how one can rate the certainty of net benefit.


Members of the GRADE Working Group struggling with how to convey the concept of Overall Certainty of Evidence for a concept when fully contextualised in the guideline development process came to realise that directly expressing Certainty of Net Benefit would be clearer and more useful for guideline users. The workshop facilitators have actively developed a protocol for determining the Certainty of Net Benefit and applied it to numerous examples. The concept is currently in development within the GRADE Working Group and is not current GRADE guidance.


The 7-step process to determine the Certainty of Net Benefit is:


The Certainty of Net Benefit is a clearer way of expressing the overall confidence that the benefits outweigh harms for a particular decision or recommendation. The 7-step process allows guideline developers to explicitly determine and rate the certainty of net benefit. Workshop participants will determine the Certainty of Net Benefit for a sample recommendation.

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