Given the fact that a large part of CPG work is done by professional associations with a low budget and by voluntary health experts, strategies for adapting CPGs to multimorbidity should not exponentially increase the work that needs to be done. Apart from focusing on the most prevalent conditions, the complexity and work load could be reduced if international collaboration would be intensified. Clearly, for specific health care settings or patient populations, it is reasonable to interpret the evidence and to consent recommendations on a local level. However, in principle, synthesising the evidence is not specific to individual health systems and may be exchanged across countries. The EUnetHTA Joint Action  and the Guidelines International Network (G-I-N) , for example, are evidence that this type of international cooperation and exchange is feasible.