The results of this suggest that NP monitoring is cost effective compared to clinically-guided therapy, however this is more uncertain than the base-case results as the 95% confidence intervals of the incremental net monetary benefit now range from negative to positive. The committee discussed that the base-case results in this study may not reflect the best estimate of the relative effect of NP monitoring and suggested that the recent IPD meta-analysis data was more reflective of the clinical evidence presented in the review for this guideline. This study was assessed as being directly applicable with minor limitations. As previously mentioned, the committee agreed not to recommend NP monitoring for HFPEF patients due to the lack effective pharmacological treatments available for these patients and most of the studies did not include this population. The committee also considered that the clinical and cost effectiveness evidence for NP monitoring in heart failure patients over 75 years of age was too uncertain to make a recommendation for these patients. However, the committee considered that NP monitoring is likely to be cost 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 effective for HFREF patients under the age of 75. The committee noted the variety of monitoring protocols used in the RCTs, and raised some concern about the potential range in cost of the intervention depending on the frequency of monitoring. The most recent cost-effectiveness analysis assumed NP testing every 3 months, but that this would cease after 18 months. 