• Bada Yang, Reem A Mustafa, Patrick M Bossuyt, Jan Brozek, Monica Hultcrantz, LeeflangMariska M GMMGDepartment of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands., Holger J Schünemann, and Miranda W Langendam.
• Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. Electronic address: b.d.yang@outlook.com.
• J Clin Epidemiol. 2021 Aug 1; 136: 146-156.

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.Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

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