Intracoronary ultrasound is used to define plaque morphology and quantitative characteristics before and after coronary angioplasty. The cost of the technique was defined in 87 patients who underwent elective, noncomplex procedures: group A was composed of 37 patients without intracoronary ultrasound, who served as a control group; group B comprised 23 patients who had only pastcoronary angioplasty ultrasound; and group C was 27 patients who had pre- and postangioplasty ultrasound. Economic analysis was done for the hospital ('bottom-up' methodology of equipment, supplies, support personnel, post-PTCA room) and physician costs (using resource-based relative value scale). The cost in the cardiac catheterization laboratory was: group A=$3,679 ± $688; group B=$4,650 ± $457; and group C=$5,301 ± $835, p <0.0001. The postprocedure cost for all groups was similar. The total cost was: group A=$5,326 ± $1,135; group B=$6,815 ± $1,276; and group C=$7,240 ± $1,494, p <0.0001. Intracoronary ultrasound modified the coronary angioplasty procedure in 36% of patients. Precoronary angioplasty intracoronary ultrasound defined the luminal diameter, precluding the use of additional balloons, and thus decreased the cost approximately $650. Use of ultrasound after the procedure increases the cost approximately $200 as a result of performing additional interventions. For intracoronary ultrasound to be economically viable, the change in angioplasty technique will need to be accompanied by improved clinical outcome.