OBJECTIVES:   The aim of our study was to compare the costs and cost drivers of contrast-enhanced magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) when used to diagnose peripheral arterial occlusive disease (PAOD) from a German Hospital's perspective. METHODS: In this study we considered the direct cost attributable to the radiological department in a hospital, including proportionate investigation costs such as personnel and machine usage. The costs for contrast agents and consumer goods were considered in a second step as they vary strongly from hospital to hospital. A total of eleven examinations, each of MRA and DSA type, were documented and analyzed. RESULTS: The investigation costs for a MRA examination excluding consumer goods was found to be €142.38 and about 20% (€34.25) lower than that of a DSA-examination (€176.63), owing to the shorter occupation time of the operating room with MRA (average: 32 minutes) than with DSA (average: 58 minutes) and resulting in a lower proportional investigation costs for machine, room, and personnel per examination assuming routine operating hours of 12 hours per day at seven days a week. When the list prices for consumer goods were also regarded, there was still an advantage for MRA of €11.22 (~7%) per examination. CONCLUSIONS: For patients with suspected PAOD angiography with contrast-enhanced MRA was found to be less costly than DSA. Our results align with cost-effectiveness analyses conducted in the UK and the USA that included in addition the outcomes of diagnosis-based therapeutic decisions. Increased use of contrast-enhanced MRA for diagnostic purposes and optimization of cost drivers might promote cost reductions in radiological departments in German hospitals.