OBJECTIVES: The objective of this analysis was to estimate the cost effectiveness of commonly used antiarrhythmic agents for the treatment of supraventricular tachycardia (SVT) and intraoperative/ postoperative tachycardia and hypertension. METHODS: A decision tree model was built to examine the cost effectiveness of esmolol, metoprolol, diltiazem and amiodarone for the treatment of SVT and intraoperative and postoperative tachycardia and hypertension from a hospital perspective. The default pharmacy costs in the model were based on publicly available wholesale acquisition costs (WAC). Literature based values were used for the rates and medical costs of adverse cardiac events including myocardial infarction, stroke, hypotension, bradycardia, and ischemia. The primary efficacy parameter, rate of successful heart rate control, was based on literature values. The outcome was the cost per successful heart rate control with incremental cost effectiveness ratios (ICERs) calculated. No discounting was applied due to the short time frame of the analysis. For the probabilistic sensitivity analysis, a Monte Carlo simulation consisting of 1,000 simulations was conducted to test the joint uncertainty of all modeling parameters simultaneously. RESULTS:  The total cost of therapy was $1,250.82, $2,630.19, $2,280.21, and $1,555.14 for esmolol, metoprolol, diltiazem and amiodarone, respectively. The rate of successful heart rate control was 90% (esmolol), 64% (metoprolol), 90% (diltiazem) and 74% (amiodarone). The cost per successful heart rate control was $1,389.80 (esmolol), $4,109.67 (metoprolol), $2,533.57 (diltiazem), and $2,101.54 (amiodarone). The ICER of esmolol dominated metoprolol, diltiazem and amiodarone. In the probabilistic sensitivity analysis, esmolol was the most cost-effective antiarrhythmic in 99.6% of simulations. One-way sensitivity analyses showed the model was most sensitive to the cost of hypotension and bradycardia.  CONCLUSIONS: In this model, esmolol was the least costly and most effective antiarrhythmic. Esmolol is cost-effective in comparison with metoprolol, diltiazem and amiodarone for the treatment of SVT and intraoperative/ postoperative tachycardia and hypertension.