OBJECTIVES: Antiproliferative therapies based on paclitaxel have been developed to extend the durability of endovascular interventions for lower-extremity atherosclerotic peripheral artery disease, resulting in improved primary vessel patency and fewer target lesion revascularizations. This study evaluated the cost-effectiveness of the sustained-release, paclitaxel-eluting Eluvia stent (Boston Scientific, Marlborough, MA) compared to the paclitaxel-coated Zilver PTX stent (Cook Medical, Bloomington, IN) for endovascular intervention in the superficial femoral or proximal popliteal artery. METHODS: A state-transition, decision-analytic model was constructed from a German statutory sickness fund perspective with a 12-month time horizon. Patients entering the model were assigned to initial endovascular intervention with either Eluvia or Zilver PTX. Each month patients were exposed to the risks of primary vessel patency loss, target lesion revascularization, amputation, and death. Clinical input parameters were taken from a randomized trial (IMPERIAL) comparing the two interventions at 12-months follow-up. Cost parameters were obtained from the Fallpauschalen-Katalog G-DRG 2019. Analysis entailed sampling a complete set of clinical and cost parameters from their respective distributions, and then running cohorts of 1,000 patients through each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed. RESULTS: At 12 months, modeled primary patency was 86.9% for Eluvia and 77.8% for Zilver PTX, and mean total direct costs were €4,613 and €4,878, respectively (Eluvia average savings =€265). In probabilistic sensitivity analyses, Eluvia was cost-effective in 98.8% of all simulations at a threshold of €10,000 per primary patency loss prevented. Eluvia was more effective and less costly (dominant) than Zilver PTX in 66.7% of simulations. CONCLUSIONS: In this comparison of a paclitaxel-eluting to a paclitaxel-coated stent for endovascular femoropopliteal intervention, Eluvia was more effective and less costly (dominant) than Zilver PTX from a German statutory sickness fund perspective. These findings should be considered when formulating reimbursement policy and clinical practice guidelines.