The most recent cost-effectiveness analysis assumed NP testing every 3 months, but that this would cease after 18 months. The committee considered that this was a reasonable average, but also recognised that due to the low ICERs that even if the average frequency of monitoring were to be slightly higher that it would still be cost effective. Due to the uncertainty of the cost effectiveness of NP monitoring when the IPD data is used and the potential variation in cost of NP monitoring the committee decided to make a consider recommendation for people under the age of 75 with HF-REF . No economic evaluations were identified for those with heart failure and CKD or AF. As mentioned in the Trade-off between clinical benefits and harms section above the committee did not consider that those with heart failure with CKD should not be monitored using NP due to concern of increased risk of death, but instead be monitored by a specialist. There was no clinical evidence identified for the heart failure plus atrial fibrillation population and therefore the committee could not assess the cost effectiveness of NP monitoring in this population and no recommendation was made for this group. Other considerations A single study was included in the 2010 update (CG108) of this question30 . The committee agreed that this study should now be excluded as it no longer met the review protocol. This was due to the decision to impose a study duration threshold of a minimum of 6 months. The committee agreed that due to the chronic nature of the condition, this length of follow-up was necessary in order to be able to make appropriate recommendations. The committee discussed current practice regarding BNP measurement. It was agreed that usual practice is to measure BNP at the point of diagnosis. 