OBJECTIVES: To evaluate the cost-effectiveness and cost-utility of the implantable cardioverter–defibrillator (ICD) among patients who are at risk for sudden death in Argentina, from three insurance categories: public health, social security and private. METHODS: We developed a Markov model to evaluate the survival, quality of life and cost of the prophylactic implantation of an ICD, as compared with pharmacological therapy, among three different target populations defined using clinical trials selected through a systematic review. We measured effectiveness, resource use and cost parameters.  A healthcare system perspective was adopted and a 3% discount rate was used. RESULTS: The use of an ICD was more costly but more effective than control therapy. The cohort with the greatest benefits was represented by the MADIT I study showing an incremental cost effectiveness rate (ICER) of $8,539 (dollar 2009) for public, $9,371 for social security and $10,083 for private sector. ICERs for MADIT II population were $17,379, $18,574 and $19,799, respectively.  The secondary prevention cohort showed the worst results with ICERs of $21,016, $22,520 and $24,012. The analysis was robust to different deterministic and probabilistic sensitivity analyses, except for the cost of ICD and for battery life. CONCLUSIONS: The results varied considerably depending on the cohort and discretely according to the health system. ICD could be cost-effective in Argentina, mainly in the MADIT I patients.