OBJECTIVES: To estimate survival and costs of nesiritide versus dobutamine or milrinone in patients admitted for acute decompensated heart failure (ADHF) using Swiss University hospital costs. METHODS: We constructed a decision analytic model of hospitalisation for ADHF. Subjects started in a hospitalisation state. Survivors at discharge could be re-hospitalised or die based on a 6-month Markov process with monthly cycles. Data on survival and length of stay (LOS) in intensive care or general ward were tabulated for 9239 patients admitted for heart failure to United States hospitals included in the ADHERE patient registry. All benefits were assumed to accrue in the index hospitalisation and treatment-specific lengths of stay were estimated after adjusting for prognostic indicators. A constant factor was used to adjust US LOS estimates to reflect Swiss patterns. Age-specific all-cause mortality at six months was derived from the literature. Treatment costs are reported in 2003 Swiss francs (CHF) and include: hospital per diems (from a sample of university hospitals, and including physician costs) and medications for heart failure. The base-case was estimated for patients aged 75 years with moderate left ventricular dysfunction (ejection fraction 35-44%). RESULTS: For 1000 subjects admitted with ADHF, the number of subjects surviving at 6 months was estimated to be: 837 for initial treatment with nesiritide, 826 for dobutamine, and 833 for milrinone. The total cost of treating these cohorts is estimated at CHF 9.0 million for nesiritide, CHF 10.2 million for dobutamine, and CHF 11.9 million for milrinone. CONCLUSIONS: Based on available data, the base-case shows that nesiritide is at least as effective as inotrope therapy at reducing mortality in persons admitted to hospital for ADHF. While the acquisition cost of nesiritide is higher than that for the inotropes nesiritide is less costly than inotropic therapy at six months in Swiss university hospitals.