OBJECTIVES: The health economic impact of an additional metoprolol succinate treat-ment (METsuc) in patients with chronic heart failure (CHF) was analyzed for “real life” treatment patterns on the basis of the MERIT-HF - Trial (Metoprolol CR/XL Random-ized Intervention Trial in Congestive Heart Failure). METHODS: Based on the efficacy data of the MERIT-HF, a markov model was created to simulate the effectiveness of METsuc treatment under real-life conditions. The ad-ditional direct costs associated with METsuc were examined in relation to the number of fatalities and of hospitalizations avoided. The cost analysis was conducted from the perspective of the German Statutory Health Insurance (SHI). Base year for the cost data was 2004. Probabilities were derived from the MERIT-HF - Trial. Missing data for this approach were assessed with the help of a focus group with eight gen-eral practitioners and cardiologists. Further, the number of life-years gained was cal-culated by using the DEALE method (Declining Exponential Approximation of Life Expectancy). RESULTS: For the period observed (18 months), additional METsuc treatment does not lead to additional costs for the Statutory Health Insurance (SHI) in Germany. With the application of METsuc, costs of about 3400 EUR per fatality and almost 1800 EUR per hospitalization could be avoided. The life expectancy of a CHF patient is 1.51 years higher in comparison to standard treatment alone. Univariate sensitivity analyses were conducted to demonstrate the robustness of the results. CONCLUSIONS: The additional costs for METsuc in the outpatient sector are compen-sated by reduced expenditures in the inpatient sector as well as in the field of ambu-lance transportation. On the basis of the present analysis the treatment with metoprolol succinate represents an approach for integrated health care under a clinical as well as under an economical perspective.