OBJECTIVES: The aim of the study was to assess the incremental cost-per life-year saved with Eplerenone, an aldosterone antagonist, alongside with standard treatment for patients with post AMI heart failure, versus standard treatment alone. METHODS: A within trial study was designed. Survival gains were estimated using an extraction of comparable patients from the Saskatchewan Health Data Base. A piecewise regression model yielded death rates adjusted on patients' characteristics. Resource use was collected alongside the clinical trial. Only direct medical costs were considered. Hospital costs were calculated using French DRG costs, and the National Fee Schedule for outpatient diagnostic procedures. All costs were in 2003 Euros. A sensitivity analysis using bootstrap was used to build a confidence interval for the Incremental Cost-Effectiveness Ratio, and an acceptability curve. Costs and outcomes were discounted at five percent. RESULTS: Overall mortality over the trial period was 478 (14.4%) in the treatment group vs 554 (16.7%) in the placebo group (p = 0.008). Combined CV deaths and hospitalisations were 885 (26.7%) in the treatment group, vs 993 (30.3%) in the placebo group (p = 0.002). The discounted gain of survival was 3.2 weeks. The incremental cost per life year saved was €15,382 (95% IC: €8,274 - €42,723). Following the sensitivity analysis, 74% of the values of the ICER fell under a €50,000 per life-year saved. CONCLUSION: In France, the ICER compares with those of heart transplantation (€17,626) and of rt-PAs in the prevention of thrombotic events during the acute phase of AMI (€12,190). The main limitation of the study is the restriction to the duration of the trial. Sub-group analysis was not performed in the EPHESUS trial, and it was not possible to compute an ICER for severe heart failure patients, for which one can expect a lower cost per life-year saved.