GRADE Guidance: 31. Assessing the certainty across a body of evidence for comparative test accuracy

Bada Yang,Reem A Mustafa,Patrick M Bossuyt,Jan Brozek,Monica Hultcrantz,Mariska M.G Leeflang,Holger J Schünemann,Miranda W Langendam

doi:10.1016/j.jclinepi.2021.04.001

Abstract

ObjectivesThis article provides GRADE guidance on how authors of evidence syntheses and health decision makers, including guideline developers, can rate the certainty across a body of evidence for comparative test accuracy questions. Study design and settingThis guidance extends the previously published GRADE guidance for assessing certainty of evidence for test accuracy to scenarios in which two or more index tests are compared. Through an iterative brainstorm-discussion-feedback process within the GRADE working group, we developed a guidance accompanied by practical examples. ResultsRating the certainty of evidence for comparative test accuracy shares many concepts and ideas with the existing GRADE guidance for test accuracy. The rating in comparisons of test accuracy requires additional considerations, such as the selection of appropriate comparative study designs, additional criteria for judging risk of bias, and the consequences of using comparative measures of test accuracy. Distinct approaches to rating certainty are required for comparative test accuracy studies and between-study (indirect) comparisons. ConclusionThis GRADE guidance will support transparent assessment of the certainty for a body of comparative test accuracy evidence.

Highlights

Recommendations regarding healthcare related tests and diagnostic strategies are ideally based on studies assessing the effect of alternative testing strategies on peopleimportant outcomes [1]
We briefly introduce the concept of comparative test accuracy, the major comparative study designs, and focus on how each domain of certainty of evidence could be rated for comparative test accuracy questions
Example for risk of bias As an example, we look at the systematic review comparing the test accuracy of the human papillomavirus (HPV) test and visual inspection with acetic acid (VIA) for screening cervical intraepithelial neoplasia (CIN) 2-3 lesions [7]

Summary

Introduction

Recommendations regarding healthcare related tests and diagnostic strategies are ideally based on studies assessing the effect of alternative testing strategies on peopleimportant outcomes [1]. If such studies are unavailable, test accuracy can be used as a surrogate to assess the likely impact of tests and strategies on peopleimportant outcomes [2]. This guidance addressed the importance of establishing the purpose of a test, how to frame clear healthcare questions, and reasons for downgrading or upgrading certainty of the evidence. It did not provide detailed guidance for rating certainty in comparisons of the accuracy of two or more tests

Objectives

Methods

Results

Conclusion