Trade-off between net clinical effects and costs No previously published economic evaluations were identified assessing the cost-effectiveness of coronary revascularisation in a heart failure population; therefore the unit costs of CABG and PCI were presented to the committee for consideration of cost effectiveness alongside the clinical evidence. The committee discussed that a CABG in people with heart failure would be complex and associated with a prolonged length of stay in both the intensive care unit (ICU) and inpatient ward. The average length of stay reported in the STICH trial was 9 days. Taking these factors into account the committee agreed that the average unit cost for CABG would be at the higher end of the scale in people with heart failure of 17,714 [NHS reference cost HRG ED26A]. The committee also highlighted that additional costs would be incurred prior to a person receiving CABG due to the high cost imaging (perfusion cardiac MRI and/or an invasive angiography) required to determine the location and extent of revascularisation required and the feasibility of the procedure, further increasing costs. As mentioned in the trade-off between clinical benefits and harms section above, the population in the STICH(ES) trial is younger than the typical heart failure population. The committee discussed that there is an increased risk of mortality and complications of surgery with age and therefore agreed that CABG is unlikely to benefit the typical HF-REF population. Due to the high costs of the procedure, as well as the likely incurrence of additional costs of complications, the committee agreed that CABG is highly unlikely to be cost effective in the current UK heart failure population. The committee were uncertain about the cost effectiveness of CABG in a population that reflects those included in the STICH(ES) trial. 