OBJECTIVES:   Heart Failure (HF) admission costs are an important component of healthcare resource utilization through the developed world and especially in the above 65 age group. Cardiac Resynchronization Therapy (CRT) devices have been proven to reduce HF admissions in indicated patients. "Optimal" CRT performance requires periodic device re-programming using simultaneously perfromed cardiac ultrasounds; however, newer CRT device algorithms continuously and automatically re-program. Ultimately, this continuous optimization maximizes CRT response. We approximated healthcare system cost-savings when aCRT devices are used over “Traditional” CRT from the perspective of 4 developed geographies. METHODS: A stratified propensity score analysis estimated Clinical Composite Score (CCS) differences between technologies. HF admissions/patient-year were calculated using average rates by CCS. HF admission costs for Payers were obtained for the UK, Germany, Australia and Canada. Admission rates were extrapolated for 7 years (average CRT-D battery life). RESULTS: Basecase analyses indicate that aCRT patients could experience an estimated 0.21 less admissions per device implanted (~17% overall admission reduction) leading to a direct saving per device of GBP699 (95% CI GBP322-GBP1,001) in the UK; EUR522 (95% CI EUR185-EUR791) in Germany; AUD1,211 (95% CI AUD427-AUD1,834) in Australia; and CAD1,580 (95% CI CAD560-CAD2,395) in Canada. Sensitivity analyses which varied the timeframe of admission rate by CCS and used 0-12 month CCS admission rates estimated a mean number of avoided HF admissions could reach 0.67 (~21.51% overall admission reduction) which in turn may result in a near tripling of the payer savings mentioned above. CONCLUSIONS:   aCRT devices appear significantly cost-saving throughout diverse payment settings; estimates are likely understated since they include neither follow-up visits (which may be avoided with aCRT) nor avoided cardiac ultrasounds nor well-documented effects of HF disease progression. CRT already is proven to reduce mortality and increase QoL at a highly cost-effective level. aCRT, therefore, certainly has the potential to further improve these outcomes.