OBJECTIVES: The study aimed at performing an economic analysis in an American setting of the use of trandolapril in postinfarction patients with left ventricular dysfunction, based on the TRACE trial's individual data. METHODS: The TRACE study was a prospective placebo-controlled clinical trial designed to determine the long-term effect of trandolapril in postinfarction patients with left ventricular dysfunction. From 1992 to 1995, 1749 patients were followed. Our analysis was differential and was conducted from a Payer and a Medicare Perspectives in an American setting. Unit costs were attached to uses of resources. Mean costs per Diagnosis Related Groups (DRGs) enabled to value hospital stays for cardiovascular events. Costs of treatments were obtained by multiplying the duration of exposure by daily tariffs. The cost analysis included a longitudinal analysis and multivariate regressions to identify cost drivers. The CE analysis consisted in the estimation of the additional cost per life-saved of treating patients with trandolapril. Uncertainty surrounding the estimate of the CE ratio was taken into account through a bootstrap analysis. RESULTS: The mean costs of treatment with trandolapril reached US$550 in the Payer Perspective. It was over compensated by financial savings in hospitalisations (US$-1308). The total medical cost was lower (not significantly) in the trandolapril arm, with US$9,607 versus US$9953. There was a trend towards an increase in the cost differential in favor of trandolapril on the long run. Main cost drivers were diabetes (OR: 1.88; 95% CI: 1.4,2.5) and nitrate use (OR: 1.67; 95% CI: 1.3,2.1) at inclusion. Among 5,000 resamples of cost and mortality differentials, trandolapril was respectively cost-effective and cost-saving in 33.3% and 66.7% of the cases. The CE analysis provided similar results in the Medicare perspective. CONCLUSIONS: These results obtained in an American setting could be considered as highly cost effective.