As with any other diagnostic method, the cost-effectiveness of B-type natriuretic peptide (BNP) testing depends on the indication of its use and the specific clinical setting. The use of BNP levels, in conjunction with other clinical information, provides information that seems to be particularly helpful in the diagnosis, prognosis, and management of heart failure (HF) as well as screening for left ventricular systolic dysfunction. In the screening for asymptomatic left ventricular systolic dysfunction, BNP testing seems to be cost-effective (<$50,000 per quality-adjusted life-years gained) when used in a population with a prevalence of at least 1%. BNP testing, in fact, results in cost savings in the diagnosis of HF. Although the data are less robust, BNP seems cost-effective in the risk stratification of hospitalized HF patients when compared with echocardiography. Because BNP guidance seems to reduce the number of rehospitalizations in recently hospitalized patients with chronic HF, the use of BNP is also most likely cost-effective in this indication. For the remaining and, in part, evolving indications, further studies are needed to assess cost-effectiveness.