OBJECTIVES: To assessed the economic attractiveness of the Endeavor drug-eluting stent (DES) vs. the Driver bare metal stent (BMS) using 4-year follow-up information from the ENDEAVOR II clinical trial. METHODS: We used clinical, index procedure and follow-up events data from subjects randomized to receive Endeavor (n=598) vs. Driver (n=599), and applied Medicare cost and quality of life adjustments from secondary sources. We compared differences in clinical endpoints, medical costs, and quality adjusted survival through 4 years follow-up (1440 days). RESULTS: Patients in both treatment groups had similar baseline characteristics. The use of Endeavor vs. Driver reduced 4-year target vessel revascularization (TVR) rates per 100 subjects (10.4 vs. 21.5; difference, -11.1; 95% confidence interval [CI], -16.0 to -6.1; p<.001), with no difference in the rates per 100 subjects of death (5.0 vs. 5.2; difference, -.2; 95% CI, -2.4 to 2.7; p=.90) or non-fatal myocardial infarction (MI) (3.2 vs. 4.4; difference, -1.2; 95% CI, -3.4 to 1.0; p=.29). After discounting at a 3% annual rate, there were no differences in quality-adjusted survival days (1093 vs. 1090; difference, 3; 95% CI, -13 to 19; p=.69) and total medical costs ($21,483 vs. $21,680; difference, -$198; 95% CI, -$1608 to $1207, p=.78). CONCLUSIONS: The use of Endeavor vs. Driver was associated with a significant reduction in TVR through four years follow-up with no difference in death, non-fatal MI, quality-adjusted survival, or total medical costs. These results are comparable to those for other studies comparing DES vs. BMS.