OBJECTIVES: To evaluate the cost-effectiveness of endovascular stent treatments used in the revascularization of long lesions of the superficial femoral artery (SFA) for patients with peripheral arterial disease (PAD). METHODS: A three-state Markov model was constructed and analyzed from the societal perspective. A cycle length of six months was used to reflect the average number of days between reinterventions and the model was simulated over a lifetime time horizon with a discount rate of 3%. Mean healthcare costs were calculated for the initial procedure, follow-up, reinterventions, adverse events, and surveillance. Procedural costs were derived from the 2009 Medicare data and device costs were obtained from the March 2009 Intercontinental Marketing Services (IMS) data. The main measure of effectiveness was quality adjusted life expectancy expressed in quality adjusted life years (QALYs). Quality of life estimates were based on utilities that were derived from the literature and a multicenter, randomized, prospective study that compared the use of bare to covered nitinol stents in patients with lower limb PAD. RESULTS: For the average patient, a 66 year old male, revascularization with a covered nitinol stent decreased the number of reinterventions needed and thus, decreased lifetime expenditures compared to bare nitinol stents. The undiscounted and discounted incremental cost-effectiveness ratios (ICERs) calculated for the base case scenario was $63,675/QALY and $80,564/QALY, respectively. A one-way sensitivity analysis over the parameters for cost, adverse events, utilities, cycle length, age, and discount rate, demonstrated that covered nitinol stenting would be the preferred treatment over bare nitinol stenting except in the case at age 90 and in the case where reintervention costs for bare nitinol stenting was reduced by 25%. CONCLUSIONS: Covered nitinol stenting for the revascularization of long lesions in the SFA is a cost-effective treatment strategy compared to bare nitinol stenting.