OBJECTIVES: Nesiritide is a new technology to be introduced to the Brazilian health care system for the treatment of acute decompensated heart failure (ADHF). This study evaluated the cost impact of nesiritide versus standard care (SC) for the private hospital sector. METHODS: As no clinical or usage data were available for Brazil, we started from a published US study (Lenz, 2004) that detailed resource use of nesiritide versus SC in the treatment of ADHF over a 3 months period. Key findings were in line with other published resource use studies. Brazilian cost data (2006) were then applied to the findings. In a sensitivity analysis, key resource use items were adapted to the Brazilian clinical setting based on expert opinion and literature. RESULTS: The Lenz study demonstrated that nesiritide can impact positively on resource use: reduced length of stay in the ICU unit (1 day); reduced number of re-admissions (25.9% vs 34.2% SC); reduced need for co-medication. Applying Brazilian hospital cost data, rendered treatment with nesiritide cost-saving versus SC. For type A hospitals, treatment with nesiritide costed R$10,486 versus R$11,403 with SC, a saving of R$917 (401US$) per patient. For type C hospitals, the costs were respectively R$7782 (nesiritide) and R$8016 (SC), a saving of R$234 (US$102) per patient. In a sensitivity analysis, the longer average length of stay in Brazilian hospitals was reflected and resulted in larger potential savings. CONCLUSIONS: The cost-savings found in this study are more modest than the ones reported for US settings, reflecting the reality of lower health care costs in Brazil. However, introducing nesiritide to the Brazilian private hospital setting has the potential of reducing hospital-related costs for treating ADHF. A local observational study would be needed to confirm these results. R$: reais (Brazilian currency), exchange rate 30-05-2006