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Table 2 Key domains considered in determining the strength of recommendationsa

From: Methodological challenges in appraising evidence on diagnostic testing for WHO guidelines on hepatitis B and hepatitis C virus infection

Domain Rationale
Quality of the evidence Based on the presence of study limitations (risk of bias), inconsistency between studies, imprecision of estimates, indirectness, publication bias, and other factors. Higher quality evidence indicates greater certainty in the estimates and makes it more likely that a strong recommendation can be made.
Benefits and risks Desirable effects (benefits) need to be weighed against undesirable effects (risks). The more that the benefits outweigh the risks, the more likely that a strong recommendation will be made.
Values and preferences (acceptability) If the recommendation is likely to be widely accepted or highly valued, a strong recommendation will probably be made. If there are strong reasons that the recommended course of action is unlikely to be accepted, a conditional recommendation is more likely to be made.
Costs and financial implications (resource use) Lower costs (monetary, infrastructure, equipment or human resources) or greater cost–effectiveness will more likely result in a strong recommendation.
Feasibility If an intervention is achievable in a setting where the greatest impact is expected, a strong recommendation is more probable.
  1. Adapted from World Health Organization Guidelines on Hepatitis B and C Testing, 2017, Table 3.2 [3]
  2. aRecommendations were graded as “strong” (do in most circumstances) or “conditional” (do in many circumstances, but action may differ according to individual circumstances of the patient or setting)