This study analysed the cost-effectiveness of four different treatment modalities (medical therapy, PTA with and without stent, and surgery) for the therapy of renal-artery stenoses in hypertensive patients in Germany. A computerised, predictive decision-analytic model, based on economic input data and the cost of medical care in Germany, and the results of published data from prospective clinical trials, was developed. The economic analysis was performed from the perspective of a third-party payer. The base-case analysis showed that the primary end-point (major vascular bleeding, stroke, dialysis, or repeat arterial revascularisation) was reached at 36 months by 82.4% of the patients in the medical treatment group, 81.4% in the angioplasty group, 52.9% in the surgical group and 27.7% in the stent group. The average reimbursed treatment cost per patient after 3 years was € 9121 (medication), € 17 164 (surgery), € 14 670 (PTA), and € 8437 (stent). This resulted in a cost-effectiveness ratio of € 51 752 (medical treatment), € 36 454 (surgery), € 78 766 (PTA), and € 11 663 (stent) per event-free patient at 3 years. The accelerated cost-development after balloon dilatation was caused by higher rates of restenosis compared with primary stent implantation. The analysis of published prospective clinical data and current economic variables for renovascular interventions leads to the conclusion that a strategy using primary stent implantation is more cost-effective than stand-alone balloon dilatation. Both medical therapy and surgery offer a better cost-effectiveness ratio than PTA treatment alone.