OBJECTIVES: To assess the economic impact of using drug-eluting stents(DES) versus bare-metal stents(BMS) in patients with ST-elevation acute myocardial infarction(STEMI) in Korea from a societal perspective METHODS: A cost-minimization analysis using a decision analysis model comparing DES and BMS was performed since the mortality was comparable between two stents in a random-effects meta-analysis from a systematic review of fourteen randomized controlled trials(RCTs) with 7,654 patients. One-year time period was used since most of STEMI patients require an emergency procedure and revascularization occurs within one year. The probabilities of revascularization for each stent were derived from the meta-analysis and the rest of probabilities and costs were obtained from the national reimbursement database of Health Insurance Review and Assessment(HIRA) between 2006-2009. To identify stent-naïve STEMI patients defined as having no stenting during one-year of washout period, we used two-years of intake period with diagnosis code I21 and ER visit. We also used a micro-costing method based on six experts’ opinion. Uncertainty was evaluated using tornado diagrams and probabilistic sensitivity analyses. RESULTS: Incidence of revascularization after initial stenting was 5.42% and 11.79% for DES and BMS, respectively. The transition probabilities of DES-to-DES, DES-to-BMS, DES-to-CABG, DES-to-balloon were 62.8%, 1.5%, 4.1%, and 31.7%. The transition probabilities of BMS-to-DES, BMS-to-BMS, BMS-to-CABG, BMS-to-balloon were 52.8%, 7.6%, 0.0%, and 39.5%. The average costs of DES and BMS from HIRA data in 2009 value were US$11,007/person·year and US$9,771/person·year, respectively. Those from a micro-costing method were US$4966/person·year for DES and US$4730/person·year for BMS. DES versus BMS resulted in higher costs for US$1237/person·year using HIRA data and US$236/person·year using micro-costing approach. The model was highly sensitive to the probability and costs of having no revascularization. CONCLUSIONS: The use of BMS versus DES in STEMI patients may be a cost-saving procedure. Local large RCTs are needed to minimize the uncertainty of results.