OBJECTIVES: In light of the medicare savings debate in the US and AMNOG reform in Germany, we aim to compare average branded factory price and average annual cost of treatment for amiodarone and propafenone, the two most commonly prescribed drugs for the treatment of arrhythmia, across 6 countries (EU top 5 and US).  METHODS: A quantitative analysis was performed using the average factory prices for each branded active pharmaceutical ingredient (API) from IHS PharmaOnline International (POLI) and average annual treatment costs from IHS World Markets Cardiovascular and Metabolic service (WMCVM). We used dosing monographs to calculate the total average dosing to accommodate for regional differences in current treatment modalities. RESULTS: In the United States, the average price per mg for amiodarone is $0.006 and average annual cost of treatment is $2326. In the Germany, UK, Italy, Spain and France, the average price per mg for amiodarone is €0.025, £0.003, €0.003, €0.001 and €0.001, and average annual cost of treatment is €9216, £1147, €973, €492, €365, respectively.    In the United States, the average price per mg for propafenone is $0.014 and average annual cost of treatment is $3480. In the Italy, Spain, Germany, and United Kingdom, the average price per mg for propafenone is €0.003, €0.001, €0.0009, £0.0005, and, and average annual cost of treatment is €751, €380, €231, £124, respectively.  CONCLUSIONS: That the price and cost of amiodarone treatment is the highest in Germany is notable given the recent launch of AMNOG. Amiodarone is one of the most common comparator for cardio-metabolic drugs and its high price could allow for higher prices for newer market entrants. The relative high price and cost of propafenone treatment in the United States gives credence to proponents of health care savings who argue for systematic overhaul of drug prices.