High or moderate evidence
(is there high or moderate quality evidence?)
The higher the quality of evidence, the more likely is a strong recommendation. | □ Yes
☒ No | ⊕⊕○○ | There is moderate to low quality evidence from both randomized and observational controlled studies for recurrence rates. There is low quality evidence for other outcomes which were considered critical and important for decision-making (e.g. severe adverse events, cervical cancer). There is uncertainty for fertility and other obstetrical outcomes, and HIV acquisition/transmission was not measured. |
Certainty about the balance of benefits versus harms and burdens
(is there certainty?)
The larger the difference between the desirable and undesirable consequences and the certainty around that difference, the more likely a strong recommendation. The smaller the net benefit and the lower the certainty for that benefit, the more likely is a conditional/ weak recommendation. | □ Yes
☒ No | Risks may be reduced with double-freeze cryotherapy |
Recurrence rates of CIN I, CIN II–III and all CINs may be reduced with double-freeze technique CIN II–III, OR 0.40 (0.22 to 0.75) CIN I, OR 0.70 (0.21 to 2.28) All CIN, OR 0.37 (0.21 to 0.63)
There may be little difference in cervical cancer rates based on absolute risks There may be little difference in serious adverse events between double and single freeze cryotherapy, but there may be fewer people experiencing pain with double-freeze cryotherapy and more minor infections It is unclear whether there is little difference in fertility/obstetric outcomes
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Certainty in or similar values
(is there certainty or similarity?)
The more certainty or similarity in values and preferences, the more likely a strong recommendation. | ☒ Yes
□ No | |
High value was placed on CIN recurrence, incidence of cervical cancer, serious adverse events, resource use, and acceptability to the patient and providers Low value was placed on minor adverse events and fertility
|
Resource implications
(are resources worth expected benefits?)
The lower the cost of an intervention compared to the alternative that is considered and other costs related to the decision – that is, the fewer resources consumed – the more likely is a strong recommendation. | ☒ Yes
□ No | More resources for double freeze but benefits worth the resources |
Both interventions utilize the same equipment/ supplies Additional resources are required (provider time, patient time, more gas) for double freeze
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| Overall strength of recommendation | Conditional |
