OBJECTIVES: Beta-blockers have provided evidence of improving survival in chronic heart failure (CHF) patients. Specifically, the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II) has demonstrated a significant reduction in mortality and morbidity among patients with moderate to severe CHF treated with bisoprolol. Our aim was to investigate the economic consequence of bisoprolol therapy in CHF patients in Italy. METHODS: Data were derived from the CIBIS-II trial. We conducted a cost-effectiveness analysis, comparing standard care + bisoprolol vs standard care + placebo in the perspective of the Italian National Health Service (NHS). We identified and quantified medical costs: drug costs according to the Italian market price; specialist visits for initiation and up-titration of bisoprolol therapy and hospitalizations were quantified on the basis of the NHS tariffs (2004). Effects were measured in terms of mortality and morbidity reduction (number of deaths, life years saved and frequency of hospitalizations). We considered an observational period of 1.3 years that was the average follow-up recorded in the trial. Discounting was not performed because of the relatively short follow-up of patients. We conducted one-way sensitivity analyses on unit cost and effectiveness. RESULTS: The overall cost of care per 1,000 patients treated for 1.3 years was estimated in 2,043,700€ in the bisoprolol group and in 2,366,168€ in the placebo group, resulting in a net saving of 322,468€. The number of additional patients alive with bisoprolol was 55 per 1,000 patients, the number of LYS was 36 at 1.3 year. CONCLUSION: Bisoprolol therapy is dominant since it is both less costly and more effective than standard care. Results of sensitivity analysis showed that bisoprolol therapy remains dominant even to changes in unit cost of drug, hospitalizations and frequency of hospital admissions.