Peripheral vascular disease (PVD) significantly impacts morbidity and mortality, affecting 15% of Australians, with prevalence rising with age. Recently, drug-coated devices have become more available, showing positive outcomes in treating proximal superficial femoral and popliteal artery diseases. However, these devices come with higher costs. This study projects the 1-5 month costs of these interventions using published re-intervention rates. A systematic review of randomised controlled trials (RCTs) was conducted to determine re-intervention rates after plain old balloon angioplasty (POBA) and drug-coated balloons (DCB) in superficial femoral and popliteal artery angioplasty. The primary patency (PP) and clinically driven target lesion revascularisation (CD-TLR) rates at 12, 24, 36, and 60 months were extracted as weighted mean averages. Hospital database searches using Australian classification of health intervention (ACHI) codes identified admissions over two years involving index endovascular treatment of superficial femoral and popliteal artery disease. Costs per admission were retrieved from financial records, excluding cases with additional inseparable inpatient procedures. Primary patency rates for POBA vs DCB were: 55.2% (n=875) vs 79.5% (n=1541) at 12 months, 48.2% (n=286) vs 74.4% (n=458) at 24 months, 45.8% (n=241) vs 67.0% (n=430) at 36 months, 51.8% (n=56) vs 73.3% (n=87) at 60 months. DCB demonstrated significantly higher primary patency rates at all intervals. Thirty-eight admissions involved endovascular treatment of the superficial femoral and popliteal arteries, showing no significant cost difference between POBA and DCB. In conclusion, our cost projection supports DCB use over POBA for primary lesions in the superficial femoral and proximal popliteal arteries. DCB offers a cost-neutral method to reduce re-intervention rates in this patient population.