GRADE guidance 23: considering cost-effectiveness evidence in moving from evidence to health-related recommendations

Background: This is the 23rd in a series of articles describing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the certainty of evidence and strength of recommendations for systematic reviews, health technology assessments, and clinical guideline development. Objectives: We outline how resource utilization and cost-effectiveness analyses are integrated into health-related recommendations, using the GRADE Evidence to Decision (EtD) frameworks. Study Design and Setting: Through iterative discussions and refinement, in-person, and online meetings, and through e-mail communication, we developed draft guidance to incorporate economic evidence in the formulation of health-related recommendations. We developed scenarios to operationalize the guidance. We presented a summary of the results to members of the GRADE Economic Evaluation Project Group. Results: We describe how to estimate the cost of preventing (or achieving) an event to inform assessments of cost-effectiveness of alter-native treatments, when there are no published economic evaluations. Evidence profiles and Summary of Findings tables based on systematic reviews of cost-effectiveness analyses can be created to provide top-level summaries of results and quality of multiple published economic evaluations. We also describe how this information could be integrated in GRADE's EtD frameworks to inform health-related recommendations. Three scenarios representing various levels of available cost-effectiveness evidence were used to illustrate the integration process.Conclusion: This GRADE guidance provides practical information for presenting cost-effectiveness data and its integration in the development of health-related recommendations, using the EtD frameworks.(c) 2023 Elsevier Inc. All rights reserved.

Automated summary

This article describes the integration of resource utilization and cost-effectiveness analysis into health-related recommendations using the GRADE Evidence to Decision (EtD) frameworks. Practical guidance is provided on estimating the cost of preventing events and creating evidence profiles and summary of findings tables based on cost-effectiveness analyses. The integration process within the GRADE's EtD frameworks is illustrated using different scenarios of available cost-effectiveness evidence.