OBJECTIVES: Heart failure (HF) is a very complex condition, with a wide range of unspecific clinical symptoms rendering its diagnosis very challenging, and associated co-morbidities contributing to increased expenditures. N-terminal pro-B-type natriuretic peptide (NTproBNP) levels increase in the blood when, in the course of developing acute HF, symptoms worsen. Therefore, NT-proBNP can be used as a specific diagnostic test of acute HF, whereas in patients with dyspnea it can further help to assess prognosis. The objective of the present study was to perform a cost and budget impact analysis of NT-proBNP testing.  METHODS: A decision-analytic model formed the basis of the analysis. The model estimated the clinical consequences and outcomes and subsequent costs for patients presenting to the emergency department with dyspnea. Two diagnostic assessments were compared, NT-proBNP-supported diagnosis versus standard of care. The potential cost reduction, deriving from adequate diagnosis and prognosis/monitoring, as well as the operating reductions (i.e hospitalizations) generated by NT-proBNP implementation were estimated. Clinical inputs derived from published literature and an expert panel provided insights into standard care. Related costs were calculated according to Greek NHS official prices. The analysis was undertaken from a Greek third-party payer perspective. RESULTS: According to the model, the reduction in expenditures related to diagnosis and prognosis/monitoring with NT-proBNP use were estimated at €6.8 and €3.2 million/year respectively.  The projected net savings, considering the cost of NT-proBNP implementation (€718,000), were calculated at €9.3 million. NT-proBNP testing also generated reduced use of health care resources, by preventing 1,890 initial hospitalizations/year, leading to 10,235 fewer hospitalization days in general ward and 3,232 in intensive care unit, and avoiding 491 hospital readmissions/year. CONCLUSIONS: The overall reductions in hospitalizations and length of stay, achieved by early diagnosis and prognosis of HF with the implementation of NT-proBNP, could generate cost-savings and increase hospitals’ efficiency and productivity.