OBJECTIVES: Iron deficiency (ID) is highly prevalent in chronic heart failure (CHF) patients and imposes a significant disease burden for CHF patients with enormous impact on their outcome. Two pivotal studies (FAIR-HF and CONFIRM-HF) showed that the iron deficiency with ferric carboxymaltose (FCM), an i.v. iron, results in clinical meaningful benefits. The purpose of this study was to evaluate the cost-effectiveness of FCM versus no-treatment and oral iron supplementation in CHF patients with iron deficiency w/o anemia. METHODS: We developed a Cost-Utility-Model to simulate disease progression in CHF patients using different strategies of iron deficiency management. Markov modelling techniques were used to estimate disease progression, based on health states, defined by NYHA classes and death. Monte Carlo simulation accounted for uncertainty. The model includes 5 states and monthly transitions. Probabilities were derived from clinical and epidemiological studies. The cohort definition was adapted from the FAIR-HF study. Direct costs (NYHA, inpatient, outpatient and iron treatment costs) from published sources were used and expressed in 2014 Euro from the payer’s perspective. QALYs and total costs were projected over a 4-year time horizon and discounted at 5% p.a. RESULTS: Over a 4-year timeframe, costs and outcomes associated with FCM would amount to 18,797.39 € and 2.46 QALYs. Costs associated with oral treatment are 17,307.06 € and 2.37 QALYs (ICER per QUALY gained: €16,921.62). Costs and outcomes associated with no-treatment are 17,934.15 € and 2.3 QALYs (ICER per QUALY gained: 5,411.23 €). Due to a delayed disease progression in the FCM group NYHA costs are lower than with oral replacement and no-treatment.  CONCLUSIONS: Iv iron treatment with FCM compared with oral iron in iron deficient CHF patients is clearly below the CE threshold of €22.200-€33.300/QUALY typically used by the UK NICE and hence can be considered a cost efficient treatment strategy.