OBJECTIVES: Diabetic macular edema (DME) is an ophthalmological complication of diabetes that may lead to visual impairment and blindness if left untreated, and even despite treatment with the current standard of care, laser coagulation.  Currently, an estimated 2% of diabetics suffer from DME with vision loss. The aim of the study was to evaluate the cost-effectiveness of ranibizumab versus laser coagulation in the treatment of visual impairment due to DME. METHODS: A cost-effectiveness analysis was simulated using a Markov model adapted for Austria. The model is based on the PHIII-RESTORE trial.  Outcome measures were ‘Vision Years’ and QALY. Costs are year 2010 values. Direct medical costs comprise all treatment costs due to diabetic macular edema. The cost of blindness was incorporated using data from an Austrian cost-of-illness-analysis. The model time horizon was lifetime. The analysis was performed from the perspective of the Austrian health care system according to the Austrian Guidelines for Health Economic Evaluations. RESULTS: The model assumes 7 injections of ranibizumab in the first year and 4 injections in the second year, as well as 2 treatments with laser coagulation in the first year and one treatment in the second year. Lifetime costs amount to €17,417 for ranibizumab and to €16,286 for laser coagulation. The ICER is €5354 (incremental QALYs gain with ranibizumab of 0.22). The number of vision years is 10.19 for ranibizumab and 8.57 for coagulation; the incremental cost per additional vision year gained is €701. CONCLUSIONS: The study suggests that in Austria, ranibizumab treatment for visual impairment resulting from DME is a cost-effective strategy versus the current standard of care, laser coagulation.