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Our aim in this study was to perform a cost-effectiveness analysis (CEA) to compare myocardial perfusion magnetic resonance imaging (p-MRI) and single photon emission computed tomography (SPECT) in the Japanese setting. The CEA of p-MRI and SPECT was performed from the payer’s perspective. The subjects were outpatients who had chest pain, had no history of myocardial infarction, and showed normal or equivocal stress electrocardiogram findings. The costs of imaging techniques and treatments were assessed with the use of reimbursements of medical fees from Japanese healthcare insurance for the year 2007. Clinical effectiveness was defined in terms of the percent correct diagnosis of coronary artery disease (CAD). Data from published studies provided probabilities for the CEA, including the sensitivity and specificity of each imaging modality. We evaluated the cost-effectiveness ratio …