The committee discussed that those with severe heart failure are likely to be having much more input from specialists, similar to an MDT, when receiving usual care and therefore were not surprised that a formal MDT was not cost effective in this group of patients. One economic evaluation compared MDT involving a cardiologist and a specialist heart failure nurse compared to usual care. This was based on a RCT by Berger 201034 included in the clinical review. This cost-utility analysis found that the MDT was cost effective compared to usual care (ICER: 3,072 per QALY gained). This study also reported a third intervention consisting of NT-proBNP guided management in addition to multidisciplinary care. When this comparator is included in the analysis it dominates both MDT alone and usual care. One economic evaluation compared MDT involving a cardiologist experienced in geriatrics, specialist heart failure nurses, and a primary care physician to usual care. This was based on a RCT by Del Sindaco et al. 2007 included in the clinical review. This within-trial cost-effectiveness analysis found that the MDT approach saves 4,042 per death and/or heart failure- related admission avoided, and saves 2,155 per all-cause admission avoided. One economic evaluation compared MDT involving a cardiologist, specialist cardiac nurse and primary care physician to usual care. This was based on the PRICE RCT by Atienza 2004 included in the clinical review which also reported intervention costs. This study found that the MDT approach was less costly than usual care; however, the overall effects of the MDT were uncertain. The outcomes extracted in the clinical review show moderate quality evidence of a clinical harm of the MDT for mortality, but moderate quality evidence of a clinical benefit from reduced hospitalisations, and low quality evidence of an improvement in quality of life. 