ISBN: (b) Unable to calculate as the control group risk was not reported. (c) Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias . (d) TOPCAT used serum creatinine level 2 times the baseline value and above the upper limit of the normal range; ALDO-DHF used eGFR < 30mL/min/1.73m2, or eGFR decrease > 15mL/min/1.73m2 versus baseline. (e) Downgraded by 1 increment because the study had indirect outcomes. (f) TOPCAT: Breast tenderness or enlargement leading to study drug discontinuation; ALDO-DHF: "Gynaecomastia" (not defined) (g) Unable to calculate as there were zero events in the control arm. (h) Not the full EQ-5D, just the VAS component. (i) Time outcome reported unclear. Study states that impacts of therapy on changes in [the scores] over time were examined using a repeated-measure analysis of covariance (using all follow-up time points (4, 12, 24, 36, 48 and 60 months)) . Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 6.2.3.4 Economic evidence Published literature No relevant health economic studies were identified. Unit costs In the absence of any economic analysis, unit costs are presented in Table 43 below for consideration of cost effectiveness. Additional costs are likely to be incurred in the first year of initiation due to up- titration. These costs are presented in Table 44. 