OBJECTIVE: To generate estimates of the cost-effectiveness of combined ACE-inhibitor and calcium antagonist therapy (Tarka) versus ACE-inhibitors (usual care) in patients with heart failure after myocardial infarction in the US health care setting. METHODS: Markov process analysis techniques were used to model the health eonomic outcomes. Data on probabilities of clinical events were derived from clinical trial data and other published literature; units of health care utilization were derived from the literature and the HCUP database; prices/tariffs were derived from official lists. Study perspective was that of the third party payer. RESULTS: An analysis over the Tarka trial period shows that Tarka decreases the costs from US$24,567 to US$19,907. The mortality for Tarka is at least equal to usual care (1.96% versus 2.04%) and consequently Tarka can be considered dominant over usual care. Tarka remains cost saving over a follow-up of 5 and 10 years. The cost saving are respectively US$5120 and US$3642. The use of Tarka also leads to substantial reductions in cumulative mortality, which are respectively 9.4% and 11.7% over 5 and 10 years. The lifetime model shows that the use of Tarka leads to an incremental cost-effectiveness ratio of US$1730 per life year gained. Probabilistic sensitivity analysis showed that the probability is 55% that the incremental cost effectiveness ratio of Tarka is less than US$ 5000 per life year gained, while the incremental cost effectiveness ratio will always be less than US$10,000. CONCLUSION: The results showed that the favourable clinical benefit of Tarka results in positive short and long-term health economic benefits.