OBJECTIVES: To evaluate the costs, benefits, and incremental cost-effectiveness of non-invasive imaging of cardiac sympathetic innervation using AdreView in patients with chronic left ventricular dysfunction at increased risk for sudden cardiac death as compared to current risk stratification methods for selection of patients for implanted cardiac defibrillators (ICD) versus medical therapy. METHODS: A Markov model was developed to evaluate the impact of using AdreView for evaluating NYHA II or III heart failure (HF) patients with LV ejection fraction (EF) < 50% for treatment with an ICD.  AdreView risk-stratification was used to guide the treatment decision between ICD and medical therapy. The source of data for predicted probabilities, expected mortality rates, and treatment costs in year 2009 dollars are from the published literature and the AdreView Myocardial Imaging for Risk Evaluation in Heart Failure (ADMIRE-HF) study. The model was developed from a societal perspective using a one-month cycle time, 3% discount rate and a lifetime time horizon.  Sensitivity analysis was completed on cost, efficacy and relative risk ratios. RESULTS: AdreView had an incremental cost-effectiveness ratio (ICER) of $100,910 versus standard stratification methods. The number needed to screen to prevent one death over 5 years was 20.  The model was sensitive to changes in utility values ($91,737 - $112,123 / QALY), efficacy of ICD in low risk patients ($95,805 – $107,388 / QALY) and efficacy of ICD in high risk patients ($81,578 – $166,086 / QALY).  The model was not sensitive AdreView cost, even at 200% of baseline ($104,068 / QALY). CONCLUSIONS: AdreView is a relatively cost-effective screening strategy versus current methods that can prevent sudden cardiac deaths within as few as 20 patient screenings. Further research on the use of AdreView in real-world settings is warranted.