OBJECTIVES: Clevidipine, a short-acting, intravenous dihydropyridine calcium channel blocker, is easily titratable to achieve the desired blood pressure (BP). The ECLIPSE trials compared the safety and efficacy of clevidipine to sodium nitroprusside, nitroglycerin, and nicardipine during the perioperative period in cardiac surgery patients. We sought to gain an initial understanding of economic properties. METHODS: A decision-analytic microsimulation framework was defined to follow patients from hospital admission; assigned characteristics reflected the pooled ECLIPSE populations (1,511 coronary artery bypass graft and/or valve surgery patients aged 19-89 years). Exploratory multivariate regression analyses of the ECLIPSE data identified potential clinical and economic effects of clevidipine. Additional inputs came from administrative databases and published sources. Costs were assessed from a US health system perspective. Unit costs for intensive care and normal ward covered room and board costs only. Economic endpoints included cost per death avoided at day 30 and cost per quality-adjusted life year (QALY) gained. A life-long time horizon was adopted for the latter; costs and effects were discounted by 3% per year. RESULTS: BP control was significantly associated with time to extubation and 30-day occurrence of bleeding, renal insufficiency, death; associations with other clinical events, length of stay were non-significant. At day 30, clevidipine dominated comparators. Costs ranged from USD14,718 (clevidipine) to USD15,787 (nicardipine). Probability of survival varied slightly between agents; from 96.8% (clevidipine) to 96.4% (sodium nitroprusside). For the life-long time horizon, clevidipine showed an incremental cost-effectiveness of USD10,863 per QALY gained versus sodium nitroprusside. Nitroglycerin and nicardipine were dominated. CONCLUSIONS: Our framework provides a flexible basis for assessing economic properties of clevidipine use in cardiac surgery. The effects implemented to-date, driving economic results, come from unplanned, exploratory analyses and require independent, ideally prospective verification. Current numerical results, including cost savings, should therefore be interpreted as indicative of potential but highly tentative.