Economic One cost utility analysis found that home telemonitoring was cost effective compared to usual care, structured telephone support (human-to-machine interface), and structured telephone support (human-to-human interface) for managing heart failure (ICER: 6,616 per QALY gained compared to usual care). It also found that usual care was dominant (less costly and more effective) compared to structured telephone (human-to-machine interface), and structured telephone support (human-to-human interface) was extendedly dominated Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 compared usual care and home telemonitoring. This analysis was assessed as directly applicable with potentially serious limitations. 8.4.6 Recommendations and link to evidence Recommendations No recommendation Research recommendation No research recommendation Relative values of different outcomes The committee agreed that the critical outcomes for decision-making were all-cause mortality and all-cause hospitalisation and important outcomes were adherence to the intervention and quality of life. Quality of the clinical evidence Forty-six studies were included in the structured telephone support (STS) and telemonitoring (TM) review. The quality of the evidence ranged from very low to high. Studies were predominantly downgraded because of a risk of bias or imprecision due to wide confidence intervals. The committee noted that adherence to the intervention was not commonly reported by the studies. The authors of the Cochrane review constructed funnel plots to assess for reporting bias within the studies included in the review. This was taken into consideration when assessing the quality of the evidence for outcomes in strata which contained more than 5 studies. The funnel plots demonstrated a strong publication bias. Several outcomes also displayed statistical heterogeneity within the results reported by the studies. This was not explained by subgrouping the results by age, year of publication or the intensity of the intervention. 