This was based on the PREFER trial by Brannstrom et al. 2014 included in the clinical review. This within-trial cost-utility analysis found that this multidisciplinary approach is more effective and less costly, and therefore dominated (more effective, less costly) usual care. This study suggests that an MDT is likely to be cost saving compared to usual care. The remaining 4 economic evaluations assessed high risk patients receiving long term (greater than 6 months) MDT interventions. All of these economic evaluations were within-trial analyses based on RCTs included in the clinical review. One economic evaluation compared a basic MDT, an intensive MDT and usual care. Both MDT approaches involved a cardiologist and a specialist heart failure nurse. The basic MDT consisted of 20 hours of contact time, whereas the intensive MDT consisted of 40 hours contact time. This within- trial cost-utility analysis was based on the COACH trial by Jaarsma et al. 2008 included in the clinical review. The analysis found that the basic MDT intervention dominated (more effective, less costly) both the intensive MDT intervention and usual care. This paper also undertook sub-group analyses for patients with severe (NYHA class III/IV) and less severe (NYHA class I/II) heart failure. For patients with less severe HF again the basic MDT dominated both the intensive MDT and usual care. However, for patients with severe heart failure neither the basic or intensive MDT interventions were cost effective at 20,000 per QALY threshold compared to usual care (Intensive MDT ICER: 44,625). The committee discussed that those with severe heart failure are likely to be having much more input from specialists, similar to an MDT, when receiving usual care and therefore were not surprised that a formal MDT was not cost effective in this group of patients. 