title: GRADE guidelines: 10. Considering resource use and rating the quality of economic evidence.
abstract: OBJECTIVE
  In this article, we describe how to include considerations about resource utilization when making recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
  
  
  METHODS
  We focus on challenges with rating the confidence in effect estimates (quality of evidence) and incorporating resource use into evidence profiles and Summary of Findings (SoF) tables.
  
  
  RESULTS
  GRADE recommends that important differences in resource use between alternative management strategies should be included along with other important outcomes in the evidence profile and SoF table. Key steps in considering resources in making recommendations with GRADE are the identification of items of resource use that may differ between alternative management strategies and that are potentially important to decision makers, finding evidence for the differences in resource use, making judgments regarding confidence in effect estimates using the same criteria used for health outcomes, and valuing the resource use in terms of costs for the specific setting for which recommendations are being made.
  
  
  CONCLUSIONS
  With our framework, decision makers will have access to concise summaries of recommendations, including ratings of the quality of economic evidence, and better understand the implications for clinical decision making.
authors.affiliation: Local Health Unit, Azienda USL Modena, Via S. Giovanni del Cantone 43 Modena, Modena 41100, Italy. m.brunetti@ausl.mo.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Brunetti
authors.forename: Ian
authors.initials: I
authors.lastname: Shemilt
authors.forename: Silvia
authors.initials: S
authors.lastname: Pregno
authors.forename: Luke
authors.initials: L
authors.lastname: Vale
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Oxman
authors.forename: Joanne
authors.initials: J
authors.lastname: Lord
authors.forename: Jane
authors.initials: J
authors.lastname: Sisk
authors.forename: Francis
authors.initials: F
authors.lastname: Ruiz
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hill
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: Mark
authors.initials: M
authors.lastname: Helfand
authors.forename: Robin
authors.initials: R
authors.lastname: Harbour
authors.forename: Marina
authors.initials: M
authors.lastname: Davoli
authors.forename: Laura
authors.initials: L
authors.lastname: Amato
authors.forename: Alessandro
authors.initials: A
authors.lastname: Liberati
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
mesh_terms: D003362:Cost-Benefit Analysis; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000191:economics* / Q000592:standards; D015276:Health Care Rationing / Q000191:economics; D006295:Health Resources / Q000458:organization & administration*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000191:economics*; D014481:United States