OBJECTIVES: Drug-eluting stents (DES) reduce the need for target repeat revascularization (TVR) compared with bare metal stents (BMS) but are two to three more expensive. We aim to assess the cost-effectiveness of DES in Hong Kong. METHODS: Consecutive patients undergoing percutaneous coronary intervention (PCI) at our institution from September 2009 to September 2010 were evaluated. Clinical outcome was measured by the occurrence of major adverse cardiac events (MACE), including death, myocardial infarction and clinically driven TVR. Direct healthcare costs for index procedure, TVR, and follow-up costs were assessed. An EQ-5D questionnaire was used to measure quality of life for the baseline and 6 months post PCI. The main outcome was the incremental cost-effective ratio (ICER) for additional cost per TVR avoid and per quality-adjusted life-year (QALY) gained. Costs are expressed in US dollars (1USD = 7.7HKD). RESULTS: A total of 761 patients (DES=476, BMS=285) were evaluated. Clinically driven TVR occurred in 3.6% and 4.2% of DES and BMS patients, respectively (p=0.68). One year total healthcare costs was higher for DES patients (US$13,303) than BMS patients (US$12,075, p<0.01). Both groups experienced significant improvement in health utility score at 1 year compared to baseline but there was no significant difference between DES and BMS patients (p=0.07). QALY gained for DES and BMS patients were 0.415 and 0.375, respectively (p=0.61). The incremental cost per QALY gained was US$30,700 and per TVR avoided was US$204,667. CONCLUSIONS: In this real-world PCI registry, the use of DES was associated with significant improvement in quality of life and low TVR rates which were similar in comparison with BMS. Based on these results, DES can be considered cost-effective in terms of QALY gained but not for additional TVR avoided in Hong Kong.