(a) Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the majority of studies were rated at high risk of bias, and downgraded by 2 increments if the majority of studies were rated at very high risk of bias (b) Indirectness was assessed using the QUADAS-2 checklist items referring to applicability. The evidence was downgraded by 1 increment if the majority of studies are seriously indirect, and downgraded by 2 increments if the majority of studies are very seriously indirect (c) Imprecision was assessed according to the range of confidence intervals in the individual study. The evidence was downgraded by 1 increment when there was a 20-40% range of the confidence interval around the point estimate, and downgraded by 2 increments when there was a range of >40% Chronic Heart Failure Diagnosing heart failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 5.3.4 Economic evidence Published literature No relevant economic evaluations were identified. See also the economic article selection flow diagram in Appendix D. New cost-effectiveness analysis Original economic analysis was planned for this question. However, due to a lack of diagnostic accuracy data for this cohort of patients modelling was not undertaken. 5.3.5 Evidence statements Clinical One study was identified which reported the diagnostic test accuracy of BNP for diagnosing HF in people with CKD. The study was rated as very low quality due to risk of bias, imprecision due to the range of the confidence interval around the point estimate and indirectness due a lack of information regarding the reference standard. 