This has been recognised in several ongoing randomised controlled trials of heart failure, Chronic Heart Failure Diagnosing heart failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 which are using higher NT-proBNP thresholds for the diagnosis of heart failure in people with atrial fibrillation. Trade-off between net clinical effects and costs No economic evaluations were identified comparing NT-proBNP thresholds and BNP thresholds. Unit costs of BNP and NT-proBNP were presented to the committee for consideration. As previously discussed in the quality of the clinical evidence section above, the committee agreed that NT-proBNP was a better test than BNP. They were therefore reassured that that the average cost difference between the two tests was only around 4. They discussed that there was some uncertainty in these estimates due to the limited sample size, although there was some overlap in costs where NT-proBNP was less expensive than BNP. The committee also mentioned that the purchase of new equipment for analysing NT-proBNP is not necessary as there are kits available for all main systems. Therefore the committee did not consider that there would be further cost implications beyond those reflected in the costs above. The committee were also aware that NT-proBNP is due to come off patent in the next couple of years and therefore expect the cost of NT-proBNP to decrease. Furthermore, the committee noted that as NT-proBNP overall had a higher sensitivity compared to BNP, there is potential for some offset of the current higher cost of NT-proBNP due to reduced number of false negative results for people being tested with NT-proBNP compared to BNP. A false negative result would either require re-testing, or could result in hospitalisation if an acute episode occurred prior to diagnosis. 