OBJECTIVES: Approximately 230,000 percutaneous coronary interventions (PCIs) were performed in the Germany in 2005. PCI complications often increase resource utilization. New antithrombotic therapies have the potential to improve outcomes and decrease costs. The ACUITY and HORIZONS-AMI studies demonstrated improved clinical event rates (mortality and bleeding) using bivalirudin compared to a heparin-plus-GPI regimen. This analysis evaluated the economic impact of this improvement in the German hospital setting. METHODS: A budget-impact model was developed to evaluate the impact of bivalirudin in unstable angina (UA)/non-ST-elevated myocardial infarction (NSTEMI) patients undergoing PCI in a German hospital. Clinical data for the model were derived from the ACUITY trial and included 30-day event rates for major complications (major and minor bleeding as defined by trial protocol, Q-wave myocardial infarction, repeat PCI and coronary artery bypass graft [CABG]). Economic data were derived from the medical literature, including clinical outcomes as well as ward costs (both regular and ICU/CCU) and pharmaceutical costs. Additional analysis using resource use data from the ADONIS registry was performed.  A subgroup of high risk patients (per ESC definition) was also examined in the model. RESULTS: For UA/NSTEMI patients, overall average per procedure cost was €5347 with heparin plus GPI and €4822 with bivalirudin. In 100 PCI patients, bivalirudin use would result in 3 fewer major bleeding events (3.1%) and 11 fewer minor bleeding events (10.7%).  Total hospital costs comparing 100% heparin-based strategy to 100% bivalirudin-based strategy were €341,473 and €289,025, respectively, resulting in a cost-savings with bivalirudin of €52,448 (15%).  For high risk UA/NSTEMI patients the cost-savings over 100 procedures are €56,233 (16%). CONCLUSIONS: A bivalirudin-based strategy for anticoagulant use in UA/NSTEMI patients undergoing PCI is associated with favorable clinical and economic outcomes when compared with heparin plus GPI in a German hospital setting.