OBJECTIVES: Multiple publications have reported the positive effects of rehabilitation in cardiac patients, also post-percutaneous coronary intervention (PCI). However, the cost remains an important hurdle for the payer to fully support cardiac rehabilitation. The aim of this study was to, retrospectively, assess the clinical outcomes and associated costs of patients who underwent PCI with or without rehabilitation in a Belgian hospital. METHODS: The patient files of 213 consecutive patients who underwent a PCI between February 1998 and December 1999 were analysed in January 2006. 133 patients started a 3-month rehabilitation program, 80 did not. All major adverse cardiac events (including angina, MI, re-PCI or CABG, other hospitalisation, cardiovascular and other death) were reported. All the events that occurred over the study period were costed using unit cost data from the payer's perspective obtained from official sources. The cost of one rehabilitation session is €23.25. RESULTS: The average follow-up period was 4.8 years. The average number of rehabilitation sessions performed was 42.1. Less (not significantly) patients in the rehabilitation group were re-hospitalised (43% vs. 56%; p=0.065) and the number of re-hospitalisations (more than 1 per patient) for angina (45% vs. 75%; p<0.01) and revascularizations (8% vs. 18%; p<0.05) was significantly reduced. Mortality was not different between the treatment groups. The average cost per patient over the 4.8 years study period was €4,862 (st.err €529) in the rehabilitation and €5,498 (st.err €741) in the no rehabilitation group (p=NS). Patients in the rehabilitation group were younger (p<0.01) but logistic regression analysis (univariate and multivariate) showed no significant effect of age on angina and revascularization incidence in the total population. CONCLUSIONS: The cost of cardiac rehabilitation is more than totally offset by the significant reduction in cardiac events. Based on this study a cardiac rehabilitation program should be installed in all patients undergoing PCI.