Table 4.

GRADE summary of certainty

PDD TURBT vs WL TURBT
Patient or population: bladder cancer Setting: hospital Intervention: PDD TURBT Comparison: WL TURBT
Outcomes		Number of patients (studies)	Certainty of evidence (GRADE)	Relative effect (95% CI)	Anticipated absolute effects
					Risk with WL TURBT	Risk difference with recurrence rates
12 mo	Combined	833 (6 RCTs)	⊕⊕⊕◯ Moderate	RR 0.73 (0.45–0.82)	387 per 1000	96 fewer per 1000 (146 fewer to 32 fewer)
	HAL	731 (5 RCTs)	⊕⊕⊕◯ Moderate	RR 0.73 (0.46–0.87)	356 per 1000	105 fewer per 1000 (155 fewer to 46 fewer)
	5-ALA	102 (1 RCT)	⊕⊕⊕◯ Moderate	RR 0.71 (0.22–1.09)	608 per 1000	176 fewer per 1000 (316 fewer to 46 more)
24 mo	Combined	539 (4 RCTs)	⊕⊕⊕◯ Moderate	RR 0.75 (0.62–0.91)	504 per 1000	126 fewer per 1000 (191 fewer to 45 fewer)
	HAL	437 (3 RCTs)	⊕⊕⊕◯ Moderate	RR 0.72 (0.57–0.90)	464 per 1000	130 fewer per 1000 (199 fewer to 46 fewer)
	5-ALA	102 (1 RCT)	⊕⊕⊕◯ Moderate	RR 0.82 (0.60–1.13)	667 per 1000	120 fewer per 1000 (267 fewer to 87 more)
12 mo	RFS	1782 (9 RCTs)	⊕⊕⊕◯ Moderate	HR 1.14 (1.05–1.23)
24 mo	RFS	925 (5 RCTs)	⊕⊕⊕◯ Moderate	HR 1.25 (1.15–1.35)

5-ALA = 5-aminolaevulinic acid; CI = confidence interval; GRADE = Grading of Recommendations Assessment, Development and Evaluation; HAL = hexaminolaevulinate; HR = hazard ratio; PDD = photodynamic diagnosis; RCT = randomised controlled trial; RFS = recurrence-free survival; RR = recurrence rate; TURBT = transurethral resection of bladder tumour; WL = white light.

Certainty rating downgraded by 1 for a high/unclear risk of bias.