Assessing the certainty across a body of evidence for comparative test accuracy

Tags: Poster
Yang B1, Mustafa R2, Bossuyt P1, Brozek J3, Hultcrantz M4, Leeflang M1, Schünemann H2, Langendam M1
1Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, 2Michael G De Groote Cochrane Canada; McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, 3Michael G De Groote Cochrane Canada and McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, 4Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)

Background: Development of recommendations for healthcare related tests and strategies may require evidence on the relative accuracy of competing testing strategies. Evidence synthesis methodology and the GRADE Working Group did, so far, not provide detailed guidance for rating certainty in comparative test accuracy.

Objectives: To develop 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.

Methods: Through an iterative brainstorm-discussion-feedback process within the GRADE Working Group, we extended the existing GRADE guidance for assessing certainty of evidence for test accuracy [1] to scenarios in which two or more index tests are compared.

Results: Rating the certainty of evidence for comparative test accuracy shared many concepts and ideas with the existing GRADE guidance for test accuracy. The rating in comparisons of test accuracy required 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 were required for comparative test accuracy studies and between-study (indirect) comparisons.

Conclusions: This guidance will help provide a transparent assessment of the certainty of comparative test accuracy evidence, and facilitate the use of such evidence in decision-making regarding healthcare tests and strategies.

Patient or healthcare consumer involvement: Patients or healthcare consumers were not involved in the design or execution of this study.

1. Schünemann HJ, Mustafa RA, Brozek J, et al. GRADE guidelines: 21 part 1. Study design, risk of bias and indirectness in rating the certainty across a body of evidence for test accuracy. J Clin Epidemiol. 2020; doi: https://doi.org/10.1016/j.jclinepi.2019.12.020