A major challenge for all health care systems is to identify the most efficient use of limited and finite resources available for health care. Economic evaluation provides a balance sheet of the benefits, harms and costs for making choices between alternative health care services and is one strategy to assist decision-makers to make rational choices about effective and efficient health care. Cost and outcomes data collected on two or more alternatives form the basis for economic evaluations and calculating a cost-effectiveness ratio. While comprehensive cardiac rehabilitation has been shown to be an effective intervention for patients with documented heart disease, the economic evaluation data from which to determine the efficiency of cardiac rehabilitation are limited. Available economic evaluations of comprehensive cardiac rehabilitation suggest that it is a cost-effective intervention following an acute coronary event that can be economically justified. Although the majority of data from studies with less rigorous designs suggest either savings or a decrease in health care utilization, there were increased costs per quality-adjusted life year gained in the only randomized controlled trial with a cost-effectiveness analysis of cardiac rehabilitation. As the traditional delivery of cardiac rehabilitation services is undergoing re-examination, there is a need for considerably more research on the cost-effectiveness of cardiac rehabilitation before any definitive statement about reimbursement is made.