OBJECTIVES: Map and cost the patient pathway for acute and chronic heart failure patients in Ireland. Obtain the key cost parameters using a top down approach, whilst highlighting the economic and societal impact of this non communicable disease. METHODS: A prevalence based top down approach was applied to estimate the cost of heart failure in Ireland for the year 2012, taking a societal perspective. Data on primary and all case diagnoses were obtained from the National Hospital In-Patient Enquiry Scheme (HIPE). Market research identified admissions in private hospital. Patients hospitalised with heart failure have been taken as representative of patients with Acute Decompensated Heart Failure (ADHF). All treatment pathways associated with the direct cost of both prevalent and incident cases of heart failure were confirmed and validated by health care professionals in primary and secondary care settings. Indirect and economic costs consisted of informal care and Life Years Lost (LYL), respectively. These were estimated using national surveys and registries, such as the Central Statistics Office (CSO). LYL were monetised using Irish specific life tables and the value of a statistical and/or the QALY threshold. Where data were lacking or uncertain, treatment algorithms were confirmed and validated through scientific engagement with key opinion leaders. RESULTS: The total cost of heart failure in Ireland for the year 2012 was estimated at €662.3 million. Indirect and economic costs were identified as the largest cost component at €473.7m (76%), while the direct cost represented 24% of the cost burden. CONCLUSIONS: Once HF has developed, the pathophysiology of the condition is characterised by high morbidity and mortality, frequent hospitalisation, and a large reliance on informal care. This study identified large regional variation in available heart failure services, hence impacting the necessary follow up care. As a result, a substantial cost driver in the management and care of heart failure patients is informal care. This cost has not been considered in previous heart failure studies, making it an important area for future research.