OBJECTIVES To perform health economic evaluation of iso-osmolar Iodixanol vs. low-osmolar contrast media in patients undergoing coronarography. METHODS The decision tree modeling was performed using literature data on dosage, efficacy and safety. Iopromide as one of the commonly used low-osmolar contrast in Russia was chosen for comparison. Efficacy of Iodixanol and Iopromide was equal, so only safety issues were taken into consideration. Costs of procedure including side effects management were calculated using experts interview in Moscow clinics and hospital cost estimates. Cost-minimization analysis (CMA) from health care system perspective was performed. RESULTS According to McCullough PA, et al. (2006) the rate of contrast-induced nephropathy (CIN) was 1.4% for Iodixanol and 3.5% for Iopromide in common population, 2.8% and 8.4% in patients with chronic kidney disease (CKD), and 3.5% and 15.5% in patients with diabetes mellitus combined with CKD. Rihal CS and colleagues (2002) showed that CIN patients required haemodialysis in 7.9%. They demonstrated 22% mortality compared to 1.4% of patients with normal renal function. Hypotension rate was 20.1% and 9.1%, acute heart failure was 11.4% and 3.1%, cardiac arrest was 11.4% and 1.5%, respiratory distress-syndrome was 9.4% and 0.7%, and myocardial infarction was 3.9% and 0.9% respectively. The cost savings following the use of Iodixanol compared to Iopromide in coronarography averaged 2287 RUB (72 USD) in common population, 2866 RUB (USD91) in patients with CKD, and 3427 RUB (US$109) in patients with diabetes mellitus and CKD. CONCLUSIONS The results of this study demonstrated Iodixanol to be cost-saving compared to low-osmolar contrast media both in risk groups and in general population.