What is the decision-making framework?
The Ontario Health Technology Advisory Committee (OHTAC) has adopted and applied the excellent international work done by others in the development of GRADE for grading quality of evidence. As part of the systematic review, the relevant research is critically assessed and the quality of the pooled research (body of evidence) is determined according to the GRADE system. This assessment determines the overall quality of the body of evidence after considering the study design, methodological quality (threats to validity), the consistency of study results (e.g. direction and magnitude), and the directness of the evidence (e.g. generalisability). In addition, other modifying factors are considered, including the presence of imprecise or sparse data, strong or very strong associations, high risk of reporting bias, evidence of a dose-response gradient and the effect of all plausible residual confounding. This process yields an overall quality rating of the body of evidence (by outcome measure
