(d) Within-trial analysis and therefore does not reflect the full body of evidence available for this comparison. Pulignano is 1 of 5 studies included comparing MDT clinic to usual care in high risk patients. No exploration of uncertainty. Table 128: Health economic evidence profile: Home-based MDT (long intervention) vs nurse led MDT clinic (long intervention) vs usual care in high risk patients Study Applicability Limitations Other comments Incremental cost Incremental effects Cost- effectiveness Uncertainty [Netherlands] Partially applicable (a) Potentially serious limitations (b) Cost-utility analysis (health outcome: QALYs) Within-trial analysis of a RCT Population: Patients >18 years old with evidence of structural cardiac dysfunction Interventions: 1. Usual care (cardiology clinic) 2-1: cost saving and 3 (more effective and less costly) (c) Probability intervention 2 Conclusions robust to sensitivity analysis. Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Study Applicability Limitations Other comments Incremental cost Incremental effects Cost- effectiveness Uncertainty 2. Basic MDT 3. Intensive MDT 18 month follow-up Abbreviations: QALY: quality-adjusted life years; RCT: randomised controlled trial (a) This analysis has been undertaken from a Dutch perspective using 2009 unit costs and therefore may not reflect current NHS context. Does not include important cost aspects such as procedures during hospital admission. EQ-5D was not used. (b) Probabilistic sensitivity analysis was not presented at 20k/QALY. No discounting was undertaken; however the time-horizon was only 18 months and so is unlikely to have a significant effect. Excluded drug costs, cost of procedures conducted during hospitalisation or short term hospital admission as not rigorously reported in associated trial. (c) This study also reports results for sub-groups according to NYHA class. In patients with less severe heart failure (NYHA class I-II) intervention 2 dominates interventions 1 and 3. 