OBJECTIVES: Clinical trials have shown that candesartan, an angiotensin II receptor antagonist, improves survival and reduces hospitalisation rates in patients with chronic heart failure (CHF) and a reduced left ventricular ejection fraction (LVEF£40%). This study assessed the cost-effectiveness of candesartan in the management of CHF in Belgium. METHODS: Based on the outcomes (mortality, hospitalisation rate, cardiovascular events) reported in the CHARM Programme (Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity), a decision model was developed predicting the cost-effectiveness of candesartan compared to placebo added to current standard treatment (including diuretics, β-blockers, digoxin) of CHF. Two populations with a LVEF£40% were analysed: those who were intolerant of ACE-inhibitors (“alternative group”) and those who were simultaneously treated with ACE-inhibitors (“added group”). Direct costs from the health care payer's perspective (2004) were used. Effects were expressed as Life-Years gained (LYG). The time horizon of the model was 3.14 years, based on the follow up time in the CHARM programme, but also takes into account that patients who survived the study period gain life years and incur extra costs afterwards. An annual discount of 3% was applied on costs and effects. The average cost per day of candesartan (based on the average daily dose taken from the CHARM-programme) was €1.06 in the “alternative” and €1.08 in the “added group”. RESULTS: The incremental cost-effectiveness ratio was €1,214/LYG [95%CI €-8,365 - €14,136] in the “alternative” and €2,310/LYG [95%CI €425 - €3,920] in the “added” group. Sensitivity analysis showed the robustness of the results. Monte Carlo analysis showed that, using a threshold of €20,000/LYG, candesartan was cost-effective in 93.4% in the “alternative” and in 99.8% in the “added” group. CONCLUSIONS: Administering candesartan to Belgian patients with a LVEF£40% whether or not they are treated with ACE-inhibitors seems cost-effective from the health care payer's perspective.