OBJECTIVES: Chronic heart failure (HF) is a major cause of morbidity and mortality and a growing burden to the healthcare system. The objective was to assess the cost-effectiveness of candesartan cilexetil, an angiotensin II type 1 receptor blocker (ARB) for the treatment of HF in the Austrian setting. METHODS: A pre-specified economic evaluation was conducted on resource utilization prospectively collected alongside the CHARM programme. We examined the effect of adding candesartan in all 7599 patients randomized. All patients were considered to have been managed in Austria. Our analysis takes the perspective of a third party payer. CHARM consisted of a series of parallel randomized clinical trials comparing candesartan with placebo (standard therapy) in patients with NYHA Class II-IV HF: - CHARM-Alternative (LVEF≤ 40% patients not receiving ACE inhibitors because of previous intolerance); - CHARM-Added (LVEF≤ 40% patients currently receiving ACE inhibitors); - or CHARM-Preserved (LVEF ≥ 40% patients). Primary outcome of the overall programme: all-cause mortality; for the component trials: composite of cardiovascular death and hospital admission for HF. Resource use was collected prospectively on drug treatment, patients admitted to hospital, admissions for cardiovascular reasons, and procedures/operations. These data were used to determine the additional direct costs incurred, and potential savings made with candesartan. Unit costs were elicited from published Austrian sources in accordance with local guidelines. 2008 was chosen as the price year. RESULTS: Adjunctive treatment with candesartan in CHARMAlternative and CHARM-Added led to clinical benefits and, depending on the trial, to either cost savings or low additional costs. CONCLUSIONS: Not only does candesartan improve all important clinical outcomes in HF but also offers these benefits at little or no additional cost to the health care system; indeed, its use in patients with HF and reduced LV systolic function may lead to an actual reduction in the direct costs of healthcare in Austria.