OBJECTIVES: To evaluate the cost-effectiveness of radial compared to femoral arterial access in diagnostic coronary arteriography and percutaneous coronary intervention in adult patients with cardiovascular disease in Colombia. METHODS: A one-month time horizon decision-tree model was constructed to determine the incremental cost of radial approach in comparison to the most commonly used femoral access in diagnostic coronary arteriography and in coronary intervention in adult patients with cardiovascular disease. Costs (in 2015 Colombian pesos, 1 €= 3041 COP) of the procedures and their complications as well as effectiveness in terms of avoided complications (extracted from a review of the literature) were evaluated. Only direct medical costs, from the third party payer perspective (Colombian health care system) were assessed. Complications considered were: Major adverse cardiovascular events (death, myocardial infarction, coronary artery bypass surgery and stroke), major bleeding, failures in the procedure, minor complications and arterial thrombosis. Univariate and probabilistic sensitivity analyses were performed. RESULTS: The estimated weighted average cost of coronary angiography with radial approach was €357, while femoral access would cost €392. For percutaneous transluminal coronary angioplasty (PTCA) the average cost for radial approach would be €2,446, and for femoral €2,909. The radial approach was dominant for major adverse events averted; and despite having more minor complications (failures in the procedure, minor and arterial thrombosis) than femoral approach, it generates lower costs. The conclusion did not change under sensitivity analysis. CONCLUSIONS: Radial approach for diagnostic coronary angiography and for PTCA is dominant when compared with the femoral approach for major cardiovascular adverse events, since it is associated with a lower incidence of major complications and has a lower cost.