Trade-off between net clinical effects and costs Six published economic evaluations were identified for this review. Four of the studies were excluded as they were considered to have very serious limitations, and one study was selectively excluded due to the availability of more applicable evidence. Reasons for exclusion are provided in Appendix J. Therefore, only one study was included in this review. This is a UK cost-utility analysis comparing STS with human to human contact, STS with human-to- machine contact, TM and usual care. The study found TM to be the most cost effective intervention (ICER: 6,616 per QALY gained compared to usual care). This study was assessed as directly applicable with potentially serious limitations. The economic evaluation was based on a network meta-analysis (NMA) comparing the interventions stated above. The committee acknowledged the difference in treatment effects determined in the guideline review and the Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations No recommendation Research recommendation No research recommendation NMA. However, as mentioned in the Trade-off between clinical benefits and harms section, overall the committee were concerned that the effects of both STS and TM in both systematic reviews were being overestimated due to the likely sub-gold standard care within the usual care arms. In addition, the committee were concerned about the large disutility applied for a heart failure hospitalisation in the model. They considered the disutility was applied for too long and as a result would skew the results towards the interventions being cost effective compared to usual care. Taking both of these limitations into account it was considered that the results from this economic evaluation suggesting that usual care had a 0% probability of being cost effective were unlikely to be true for current UK practice. 