NP monitoring was also found to be cost effective in patients with CHF and LVSD 75 years old [ICER: 5,392 per QALY gained], however this is uncertain as there is only a 68% probability that NP monitoring is cost effective at the 20,000 threshold. The committee noted that a larger proportion of the population were less than 75 years old in these trials, so the result for any age could be driven by this group. This study also found that NP monitoring is cost effective compared to both usual care in the community and usual care by a specialist for patients with CHF of any cause at any age [ICER: 14,694 per QALY gained comparing Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations Consider measuring NT-proBNP (N-terminal pro-B-type natriuretic peptide) as part of a treatment optimisation protocol only in a specialist care setting for people aged under 75 who have heart failure with reduced ejection NP monitoring to specialist management]. The probability that NP monitoring is cost effective at the 20,000 threshold is 84%. NP monitoring is also found to be cost effective for the two age sub-groups (75 and under, and greater than 75), but again reflected the results found for those with CHF and LVSD, with greater uncertainty in the result for those older than 75 (50% probability cost effective at 20,000 threshold) than those under 75 (98% probability cost effective at 20,000 threshold). The committee noted that the majority of patients in the trials used for the analysis had HF-REF. The committee noted that this analysis only included 4 of 13 studies included in the clinical review and therefore may not reflect the most recent clinical evidence. This study was assessed as directly applicable with minor limitations. 