OBJECTIVES: To evaluate the cost-effectiveness of using levosimendan compared with dobutamine, in the perioperative treatment of patients undergoing cardiac surgery who require inotropic support. METHODS: A two-part Markov model was designed to simulate health state transitions of patients undergoing cardiac surgery, and estimate the short- and long-term health benefits of treatment. Hospital length of stay (LOS), mortality, medication and adverse events were key clinical and cost inputs. Treatment cost-effectiveness was evaluated in terms of costs, incremental cost per Life Years (LYs), and incremental cost per Quality-Adjusted Life Years (QALYs) gained within the German healthcare system. Drug prices were calculated from the German Drug Directory (€/2014) and published literature, with a 3% yearly discount rate applied. The base case analysis was for a one year time horizon. RESULTS: The use of levosimendan versus dobutamine was associated with cost savings of €4787 per patient from the German hospital perspective. These cost savings were due to reduced adverse events and shorter hospital LOS, leading to increased bed capacity and hospital revenue. Excluding revenue gains, the incremental cost per LY was €9115 and incremental cost per QALY was €11,919 for levosimendan versus dobutamine. Levosimendan was 95% to 100% likely to be cost-effective at a willingness to pay threshold of €20,000 to €40,000 per QALY. Probabilistic sensitivity analyses demonstrated that results were robust to parameter changes.  CONCLUSIONS: The use of levosimendan in patients undergoing cardiac surgery who require inotropic support is cost-effective and potentially cost-saving compared with dobutamine.