OBJECTIVES: Nebivolol was demonstrated to be clinically effective in patients with chronic heart failure (CHF) in the SENIORS, the trial mirroring the real life CHF population . The aim of this analysis is to assess the cost effectiveness of nebivolol compared with standard treatment in elderly patients with heart failure. METHODS: An individual patient simulation model, based on a Markov modeling framework, was developed to estimate life time costs and quality adjusted life years (QALYs) for patients starting treatment at the age of 70. The model consisted of five health states defined by NYHA class and death. Patient faced different risks of cardiovascular events or death. The risk of each event in a given cycle was based on patients' baseline characteristics and time on treatments. Input data for the model were populated using individual patient data from the SENIORS trial. Sensitivity analysis explored the implications of different starting treatment cohort groups and lengths of treatment benefit. Internal validation compared model and trial based results for different durations of treatment. RESULTS: In the base case analysis, the total cost per patient was £4568 and £6287; mean life-years were 7.547 and 8.378; and QALYs were 5.2 and 5.844 over life time for patients aged 70 at starting of treatment for the standard treatment and nebivolol groups respectively. The probabilistic sensitivity analysis provided the incremental cost effectiveness ratio was £2069 (95% CI 1947 to 2217)) per life year, and £2670 (95% CI 2475 to 2918) per QALY. CONCLUSION: This analysis indicates that nebivolol is highly cost-effective treatment for elderly patients with heart failure compared to placebo. Strengths of our analysis included being based on individual patient simulation, extending the Markov modeling framework to enable the risk of events to be varied over time.