Medical device manufacturers operate under strict regulatory requirements and high expectations for quality and cost performance. The present work deals with such a medical device machine shop that needs to decide between a new 3-axis vertical machining center and a more automated 5-axis CNC to expand capacity for precision housings. The research problem is to determine which CNC alternative provides superior economic performance and strategic value under realistic shop conditions. Engineering-economy method of annual cash-flow analysis and capital recovery has been applied at a minimum attractive rate of return (MARR) of 18%. Data on purchase price, salvage, production rates, availability, scrap, labor, maintenance, tooling, consumables, energy, and overhead were collected from company records and vendor quotations. The study estimates total cost of ownership (TCO), machine cost per good part, annual net cash flows, and a simple annual return on investment (ROI) for each CNC option. Results show that although the 5-axis machine has higher ownership and operating costs, its higher throughput and lower scrap rate yield a lower cost per finished part, significantly higher annual net cash flow, and a higher ROI than the 3-axis alternative. Theoretically, the case illustrates how classical engineering-economy tools can structure CNC investment decisions alongside more complex multi-criteria selection approaches. Practically, it demonstrates that purchase price alone can be misleading; in a regulated medical device environment where the cost of quality is substantial, managers should evaluate CNC alternatives on lifecycle economics, cost per good part, and alignment with capacity and quality objectives.