OBJECTIVES: Regadenoson, a newer adenosine derivative, has improved pharmacologic properties that may improve safety profile and administrative requirements compared to adenosine and dipyridamole. This study assessed the economic benefits of utilizing regadenoson in myocardial perfusion imaging (MPI). METHODS: Data on the overall laboratory and individual staff time spent on MPI procedures and managing adverse events was collected from 141 cardiovascular laboratories. Direct laboratory MPI cost was estimated by applying hourly labor and fringe benefit rates to the amount of time each staff was involved in the test. In addition, the cost of the agent and its administration also was applied. Regression analysis was used to examine the association between laboratory characteristics and the weekly number of tests. The estimated adjusted mean values were used to test the sensitivity of results to this parameter.     RESULTS: Assuming a set number of 20 tests/week with adenosine and dipyridamole, shorter overall test time with regadenoson (mean [±SD] of 156±46 minutes vs. 182±63 minutes with adenosine and 191±61 minutes with dipyridamole) and utilization less of laboratory resources resulted in an additional 177 and 244 tests/year with regadenoson vs. other agents, respectively. The annual savings with regadenoson were $17,377 vs. adenosine and $36,677 vs. dipyridamole in laboratory personnel cost and $91,165 vs. adenosine in total cost. Regadenoson resulted in $112,134 higher annual total cost compared to dipyridamole due to higher drug-related costs. CONCLUSIONS: The findings from this analysis suggest that regadenoson will reduce the direct cost of MPI by decreasing the procedure and monitoring time and increasing patient throughput. These findings will be of interest to laboratory administrators and payers.