OBJECTIVES: Heart failure is quite common in elderly patients with type 2-diabetes. Screening could potentially improve health outcomes at acceptable costs through early detection and adherence to current prescription guidelines. Based on a prospective study the cost-effectiveness of different screening strategies to detect heart failure in patients aged 60 years with type 2-diabetes was assessed. METHODS: Data obtained from our prospective study and literature were used in a Markov model with a lifetime horizon to evaluate the incremental cost-effectiveness ratio of five increasingly extensive screening strategies. Differences in survival rates estimated by the Seattle Heart Failure Model between patients with undetected versus detected heart failure, induced by medication use, were used to adjust input parameters for health states related to undetected heart failure. Estimates for costs, utilities, and transition probabilities were additionally adjusted to age and NYHA class. Scenario analyses were performed to evaluate the impact of screening age and medication prescription and effectiveness. Probabilistic sensitivity analysis was performed to assess robustness of the results. RESULTS: For both men and women usual care (no screening) had the highest probability of being cost-effective when the willingness to pay (WTP) was small. For WTP values in the range of €4,600/QALY-€27,000/QALY for men and €5,200/QALY-€40,000/QALY for women evaluation of the electronic medical record and symptoms had the highest probability of being cost-effective. For higher WTP values echocardiography was the preferred strategy. For all screening strategies cost-effectiveness improved if prescription of heart failure medication was optimal or screening was started at the age of 70 years. CONCLUSIONS: Screening for heart failure through evaluation of electronic medical record and symptoms has favorable cost-effectiveness and echocardiography may also be acceptable at higher WTP values. The benefits from screening could be much larger than currently identified when test outcomes would more often lead to proper medication prescription.