Article Text

Implementing GRADE: calculating the risk difference from the baseline risk and the relative risk
1. Robert G Newcombe1,
2. Ralf Bender2
1. 1Cochrane Institute of Primary Care & Public Health, Cardiff University, Cardiff, Wales, UK;
2. 2Department of Medical Biometry, Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
1. Correspondence to
: Dr Robert G Newcombe, Cochrane Institute of Primary Care & Public Health, Cardiff University,Cardiff CF14 4YS, Wales, UK;Newcombe{at}cf.ac.uk

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Availability of high-quality estimates of the absolute difference in effectiveness between alternative treatment options is crucial to the application of evidence-based healthcare to populations of patients and corresponding decisions. One framework for assessing confidence in estimates of the effect of alternative management strategies on patient-relevant outcomes within the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system1 is summarised by Spencer et al.2 In this article we single out one of the five domains of the GRADE system, namely imprecision.

Often, the best available evidence for the absolute difference in effectiveness between a treatment under consideration and a standard regime does not come from a single study, but from two totally separate sources. Sometimes, an estimate of the relative risk (RR) of the outcome of interest between the two treatment options is available from a meta-analysis combining evidence from several randomised trials. Owing to the larger sample size available, this will in general have greater precision than an RR derived from a single study. In most contexts, estimates of relative effect of a therapy are more consistent across different baseline risks than absolute effect estimates.3 Consequently, it is a common practice in systematic reviews to report a pooled estimate of the RR, rather than the absolute risk difference (RD).2

To convert an RR into an absolute RD, we also require an estimate of the baseline risk (BR), the rate of occurrence of the event of interest when the standard treatment is used. The absolute RD is then calculated from the BR and RR using the formula RD = BR×(RR−1).

In most applications, the RR is below 1, representing a reduction in risk due to the intervention. The calculated RD is then negative. Sometimes, the RR may be greater than 1, representing an increase in risk due …

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