OBJECTIVES: To compare two different methods in evaluating cost-effectiveness (CE) of candesartan for patients with chronic heart failure (CHF) in Germany based on the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and Morbidity)-programme. METHODS: For both analyses, CE was measured by calculating incremental cost-per-avoided-event. Two analytical approaches were chosen examining two treatment groups of the CHARM-programme: “Added” (low left ventricular ejection fraction (LVEF < 40%) and “Alternative” (LVEF < 40% and intolerant of an ACE inhibitor). The first approach calculated average costs per patient based on all cardiovascular events happened (Hospital admissions due to worsening heart failure, cardiovascular deaths, cardiovascular procedures). Absolute risk reduction (ARR) to avoid/delay an event also was derived from all events occurring in the clinical trial. The second approach simulated the real life situation of patients with CHF in a Markov-analysis over 12 periods (3 years). Risk tables on mortality and morbidity were derived from Kaplan-Meier-Curves of the CHARM-protocols. ARR was determined through a Monte-Carlo-Simulation for a cohort of 1,276 patients. For both approaches, cost calculation was performed from the perspective of the German statutory health insurance (SHI). Base year for costing was 2004. Only direct costs (drug, hospital, general practitioner, specialist, ambulance, rehabilitation) were considered. RESULTS: In the case-based-costing-approach, the incremental costs to prevent/delay a cardiovascular death or a hospital admission were 516 EUR (“Added”) and 1,210 EUR (“Alternative”). The Markov-Analysis presented corresponding ratios of 2,117 EUR (“Added”) and 2,814 EUR (“Alternative”). Sensitivity analysis on costs, discounting rates and effects size showed the robustness of both models' results. CONCLUSIONS: Both analyses showed the cost-effectiveness of candesartan for patients with chronic heart failure. Conducting a simulation that considers real-life-conditions leads to higher ratios, but gives a more precise estimate of the cost-effectiveness of candesartan in a long-term-perspective.