In patients with less severe heart failure (NYHA class I-II) intervention 2 dominates interventions 1 and 3. However, in patients with severe heart failure (NYHA class III-IV) intervention 1 is the most cost effective option. Table 129: Health economic evidence profile: MDT (long intervention - case-management) vs usual care (primary +/- secondary) in high risk patients Study Applicability Limitations Other comments Incremental cost Incremental effects Cost- effectiveness Uncertainty Moertl [Austrian] Partially applicable (a) Potentially serious limitations (b) Cost-utility analysis, Markov model Population: Patients with heart failure discharged after a heart failure hospitalisation Comparators: 1. Usual care in community 2. Nurse-led MDT 20 year time horizon modelled QALYs per QALY gained (c) Uncertainty not reported for cost effectiveness Conclusions robust to sensitivity analyses (including discount rate to 3% and 0%). Abbreviations: ICER: Incremental cost effectiveness ratio; MDT: multidisciplinary team; QALY: quality-adjusted life years. (a) Austrian payer perspective. EQ-5D not used to capture quality of life - utility scores converted from MLWHF questionnaire using previously published algorithm. Costs and effects discounted at 5%. (b) Cost of GP visits and drug costs were not collected and not included in the analysis of the clinical trial phase. (c) An additional comparator was also included in the study that involved intensive NT-proBNP guided patient management in addition to multidisciplinary care. This comparator dominates (more effective, less costly) both usual care and the nurse-led MDT alone. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 9.2.5 Evidence statements Clinical Overall 22 studies were included in the review. No meta-analysis was conducted due to the heterogeneous nature of the interventions and populations in the included studies. 