OBJECTIVES: To evaluate the 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: Two CE-analyses were conducted: incremental cost-per-avoided-event and incremental cost per life-years gained. Effectiveness data were derived from the CHARM-programme which provided data on three treatment groups with CHF-patients: “Added” (low left ventricular ejection fraction (LVEF < 40%), “Alternative” (LVEF < 40% and patients' ACE-inhibitor intolerance) and “Preserved” (LVEF > 40%). Besides, an “Overall” analysis was processed. All cardiovascular events (Hospital admissions due to worsening heart failure, cardiovascular deaths, cardiovascular procedures) were extracted. Absolute risk reduction (ARR; only first events counted) to prevent/delay one event was evaluated. 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. Incremental costs between candesartan and placebo were used building a ratio with ARR. Long-term effectiveness was estimated calculating the incremental costs per life-year gained (LYG). LYG were generated using the DEALE (Declining Exponential Approximation of Life Expectancy)-approximation. RESULTS: The incremental costs to prevent/delay a cardiovascular death or a hospital admission were 2,279 EUR (“Added”), 2,763 EUR (“Alternative”), 31,015 EUR (“Preserved”) and 7,717 EUR (“Overall”). The incremental costs per life-year gained were 47 EUR (“Added”), 131 EUR (“Alternative”), 11,054 EUR (“Preserved”) and 231 EUR (“Overall”). Sensitivity analyses were conducted for all treatment groups. The results were robust to variations of costs, discounting rates and effects. CONCLUSIONS: With regard to the results of the treatment groups “Added” and “Alternative”, candesartan is a cost-effective treatment option for patients with low left ventricular ejection fraction in Germany.