OBJECTIVES: Approximately 5900 PPCIs were performed in the UK in 2007. This number is expected to double in the next 5 years post the 2008 NIAP report. New antithrombotic therapies have the potential to improve clinical outcomes and decrease costs. The HORIZONS-AMI study of bivalirudin demonstrated reduced clinical event rates (mortality and bleeding) compared to a heparin and GPI (HEP+GPI) regimen. The potential economic value of implementing bivalirudin in the PPCI setting is evaluated in this analysis from the UK hospital perspective. METHODS: A budget impact model was developed to compare treatment of STEMI patients undergoing PPCI with either bivalirudin or HEP+GPI. Clinical data for the model was derived from the HORIZONS trial, and included 30-day event rates for major complications (major and minor bleeding as defined by trial protocol, Q-wave myocardial infarction [MI], and repeat PCI and coronary artery bypass graft [CABG] procedures). UK cost and clinical practice data were derived from published sources. RESULTS: Overall average procedure cost per bivalirudin-treated patient (incorporating 7.2% provisional GPI use as per HORIZONS) was £4284, compared to £5015 per HEP+GPI-treated patient. In extrapolating these benefits to a typical NHS hospital of 200 PPCI patients per year, 7 major bleeding events (3.4%), 13 minor bleeding events (6.6%), and 2 deaths (1%) in patients would be averted if treated with bivalirudin. The total hospital budget impact of treating 200 PPCI patients using a HEP+GPI based strategy is £1,002,913. Introducing a bivalirudin-based strategy could save £146,129 (15%) per year. CONCLUSIONS: Using a bivalirudin-based strategy in STEMI patients undergoing PPCI is associated with favorable clinical and economic outcomes when compared with HEP+GP in a UK hospital setting.