OBJECTIVES: Coronary angiography is the current gold standard in diagnosing coronary lesions. However, coronary angiography does not definitively determine whether a lesion is ischemic or not. Compared to angiography alone, Fractional Flow Reserve (FFR) has demonstrated clinical superiority in diagnosing cardiac lesion functional severity, while concurrently providing cost savings.  The goal of this model is to demonstrate the hospital budgetary implications of utilizing FFR to guide clinical decision making in PCIs compared to angiography alone. METHODS: A customizable Excel®-based hospital budget impact model was developed for a hypothetical cohort of 500 patients with multivessel coronary disease. Cost components included procedural, device, hospital stay and cardiovascular complication costs during the one-year period after PCI. A decision tree model was utilized to convert the expected probabilities of cardiovascular complications into expected costs. Probabilities and costs were derived from The Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) clinical trial data. Costs were converted to 2011 US dollars. Sensitivity analysis was carried out over reported ranges of values of model inputs.   RESULTS: Using Fractional Flow Reserve in 20% of the multivessel cases resulted in estimated cost savings of $297,247 per year compared to using angiography alone in all of the multivessel cases. Fractional Flow Reserve usage resulted in reduced costs of the procedure, hospital stay and complications. Potential cost savings were most sensitive to variations in the cost of hospitalization and the probabilities of cardiovascular complications. CONCLUSIONS: Analysis shows that compared to angiography alone, FFR-guided coronary intervention for patients with multivessel disease both (1) reduces rates of adverse events and (2) reduces total costs including procedural, hospital and complication costs.  As such, FFR provides hospitals a cost saving technology with superior clinical outcomes as compared to angiography alone