OBJECTIVES: Cardiac resynchronization therapy with biventricular pacemaker (CRT-P) is considered an effective treatment for heart failure (HF). Adding implantable cardioverter defibrillators (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, economic evaluations have shown that incremental cost-effectiveness ratios (ICERs) of CRT-D may be substantially higher than for comparators, due to large numbers of patients which do not get additional benefits from CRT-D. Therefore, current research, like ‘Biomarkers to predict cardiac failure, arrhythmias and success of treatment’ (COHFAR), is trying to identify a set of (bio)markers that predict the response to CRT-D. The objective of this study was to review full economic models evaluating implantable CRT-D for patients with HF, compare the structure and inputs of the cost-effectiveness models and identify the main factors influencing the ICERs for CRT-D. METHODS: A comprehensive search strategy of PubMed, Embase, Web of Science identified six full economic models evaluating CRT-D against optimal pharmacological therapy (OPT) and/or CRT-P. All studies included a Markov or other state transition model for the long term follow-up of the HF patients. Four studies included a comparison of CRT-D with CRT-P while two others compared CRT-D with OPT. RESULTS: Studies differed in terms of time horizons and comparators. The inputs for the models were mainly taken from two trials, only one of which compared CRT-D and CRT-P to OPT. Generally, CRT-D was found cost-effective when compared to OPT but its cost-effectiveness became questionable when compared to CRT-P. This depended on cost of devices, mortality due to SCD and battery longevity. CONCLUSIONS: A better identification of patients that are more likely to benefit from CRT-D (i.e. those with higher risks of SCDs) will certainly have an effect on the cost-effectiveness of this technology in comparison to CRT-P.