An indication of the direction of clinical importance (if one treatment is beneficial or harmful compared to the other, or whether there is no difference between the 2 tested treatments). A description of the overall quality of the evidence (GRADE overall quality). 4.3.8 Appendix D-Practical notes The 2010 guideline included practical recommendations which covered aspects of clinical management that were not included in the evidence reviewed but which the committee considered important. In updating the guideline the committee reviewed the information included within this Chronic Heart Failure Methods NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 appendix and agreed that where appropriate these practical notes should be absorbed into the treatment and monitoring recommendations. 4.4 Identifying and analysing evidence of cost effectiveness The committee is required to make decisions based on the best available evidence of both clinical effectiveness and cost effectiveness. Guideline recommendations should be based on the expected costs of the different options in relation to their expected health benefits (that is, their cost effectiveness ) rather than the total implementation cost. However, the committee will also need to be increasingly confident in the cost effectiveness of a recommendation as the cost of implementation increases. Therefore, the committee may require more robust evidence on the effectiveness and cost effectiveness of any recommendations that are expected to have a substantial impact on resources; any uncertainties must be offset by a compelling argument in favour of the recommendation. The cost impact or savings potential of a recommendation should not be the sole reason for the committee s decision.236 Health economic evidence was sought relating to the key clinical issues being addressed in the guideline. Health economists: Undertook a systematic review of the published economic literature. Undertook new cost-effectiveness analysis in priority areas. 