Objective: Heart failure (HF) is a major public health burden in terms of mortality, morbidity and costs. Economic analyses of clinical trials and real-world studies have assessed the cost-effectiveness of drugs used to treat HF. Although a few papers have summarized the results of the earlier economic studies, new evidence has emerged necessitating an update of the cost-effectiveness literature. Methods: A literature search was conducted in MEDLINE to identify the published articles on HF from 1993 to 2007 with a focus on economic evaluations and resource use. Six review articles were found which summarized 31 economic studies for ACE inhibitors, beta-blockers and digoxin through 2004. None of the review articles had summarized the studies for ARBs, aldosterone receptor blockers, or evidence from real-world studies. Results: After excluding studies summarized in the previous review papers, we found 29 new economic analyses for drugs used to treat HF. Among these, 22 studies were based on data available from clinical trials. These included 14 cost-effectiveness analyses (CEA), 1 CEA/cost-utility analysis, 1 CEA/cost-consequence analysis, 4 CEA/cost-benefit analyses (CBA), 1 CBA and 1 budget impact analysis. The remaining analyses were studies conducted using real-world data. Five studies compared ARBs to placebos or ACE inhibitors, out of which four suggested cost-savings or cost-effectiveness for ARBs, and one showed higher costs for ARBs. For the remaining drugs, evidence that treatment was cost-saving was observed in 16 studies and that the treatment had favorable cost-effectiveness ratio was observed in 7 studies. Finally, one study comparing costs among beta-blockers found bisoprolol to be the most cost-effective drug. Conclusion: Economic studies analyzing drugs used to treat HF can help in making rational decisions regarding provision of care. However, there is need of more comparative economic studies between same class drugs to inform prescription drug decisions.