OBJECTIVES: The presence of diabetes in patients needing percutaneous coronary intervention (PCI) is associated with increased risk of adverse outcomes, such as target lesion revascularization (TLR), and thus an additional cost burden.  A recent indirect treatment comparison (ITC) showed that the drug-eluting stent (DES) CYPHERTM improved clinical outcomes vs other DES resulting in cost-savings in diabetic patients. Based on this ITC, the objective is to conduct an adaptation to Spain and compare CYPHER vs. XIENCE™ from a hospital perspective with global annual budget. METHODS: A global budget-impact model was adapted to Spain using a previously reported ITC of DES in diabetic patients. In brief, the ITC included pair-wise meta-analyses of randomized trials with a common comparator to obtain relative treatment effects for different DES and absolute TLR risk. These reported clinical estimates were added to the Spain model, along with reported use and reimbursement rates for diagnosis-related groups (DRGs) of index procedures and re-interventions in Spain. Budget-impact was estimated for 100 annual PCIs with DES for diabetic patients in a typical Spanish hospital, assuming 100% utilization for each stent and identical stent acquisition cost. Analyses were conducted using two methods for estimating TLR risk. RESULTS: Results predicted that CYPHER, if used instead of XIENCE, could save approximately 320€ to 407€ per diabetic patient annually depending on TLR risk estimation method. Assuming 100 annual PCIs in diabetic patients, this translates to cost-savings varying from 32,048€ to 40,710€. These savings are driven by reduction in secondary interventions achieved by choosing the DES with the best TLR outcomes. CONCLUSIONS: This analysis indicates that use of CYPHER versus XIENCE in diabetic patients undergoing PCI can produce important savings for hospitals. Further cost research and clinical expert validation are needed to confirm results of this local adaptation.