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Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer

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Rating the Strength of Evidence From the CER: A Modification of the GRADE Methodology

The system used for rating the strength of the overall body of evidence was developed by AHRQ for the Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews (version 1.0; available at: http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf) and was based on a method developed by the GRADE (Grading of Recommendations, Assessment, DEvelopment) Working Group. The system used four required domains—risk of bias, consistency, directness, and precision—for assessments. All assessments were made by two investigators who resolved disagreements through discussion. The strength of evidence pertaining to each key question was classified into three broad categories or grades: high, moderate, low, or insufficient.