Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 in patients over the age of 75 with CHF of any cause specialist clinical assessment was cost effective compared to specialist natriuretic peptide monitoring and usual care in the community (ICER: 11,508 per QALY gained compared to usual care in the community). Specialist natriuretic peptide monitoring was dominated by specialist clinical assessment. This analysis was assessed as directly applicable with minor limitations. One cost-utility analysis found that NT-proBNP guided intensive management was dominant (more effective and less costly) compared to nurse-led MDT management and usual care in the community. This was assessed as partially applicable with potentially serious limitations. One cost-utility analysis found that: o in heart failure patients (any cause) under the age of 75 specialist-led BNP guided therapy was cost effective (ICER: 10,057 per QALY gained) compared to specialist-led clinically-guided therapy; o in heart failure patients (any cause) over the age of 75 specialist-led BNP guided therapy dominated (less costly, more effective) specialist-led clinically-guided therapy; o in HF-REF patients under the age of 75 specialist-led BNP guided therapy was cost effective (ICER: 9,840 per QALY gained) compared to specialist-led clinically-guided therapy; o in HF-REF patients over the age of 75 specialist-led BNP guided therapy was cost effective (ICER: 8,123 per QALY gained) compared to specialist-led clinically-guided therapy; o in HF-PEF patients under the age of 75 specialist-led BNP guided therapy was cost effective (ICER: 9,066 per QALY gained) compared to specialist-led clinically-guided therapy. This was assessed as directly applicable with minor limitations. 8.2 Monitoring using repeated biomarker measurement or imaging for management of chronic heart failure in people who also have chronic kidney disease Biomarkers are substances measurable in the blood stream which can be used to diagnose and monitor disease. 