OBJECTIVES:  Comparative cost-effectiveness analysis of two treatment schemes for patients with acute decompensated heart failure: standard care and standard care plus serelaxin. METHODS:  Cost analysis was carried out on the basis of existing standards for the provision of emergency and specialized medical care to patients with heart failure in Russia. Direct costs including readmission of patients with acute decompensated heart failure within a year were calculated. The survey of Russian cardiology experts with experience in the use of serelaxin was conducted. The criterion of effectiveness in the pharmacoeconomic study was life-years gained (LYG) calculated by modelling on the basis of data on mortality and survival. This data were based on randomized clinical trials results and retrospective data analyses confirmed by the experts. For reference, the exchange rate was 1 EUR= 75 RUB. RESULTS: Serelaxin is a new medicinal drug for acute decompensated heart failure - a recombinant form of the human hormone relaxin-2 administered intravenously during 48 hours. According to the expert opinion only 7% of patients with acute decompensated heart failure are required to administer serelaxin in real clinical practice. Total costs for 100 patients in standard therapy group with serelaxin administered in 7% of patients equal 177,000 € for 12 months and in standard group only equal 166,507 €. LYG is 70,5 and 69,7 respectively. Conducted pharmacoeconomic analysis revealed that cost-effectiveness ratio (CER) serelaxin group was 2,510 €, and in standard therapy group CER was 2 390 €. Incremental cost-effectiveness ratio in serelaxin group was 12,461 €. That is 1,5 times lower than willingness-to-pay threshold in Russia. CONCLUSIONS: Treatment with serelaxin is cost-effective in comparison with standard care in patients with acute decompensated heart failure in the Russian Federation healthcare conditions.