OBJECTIVES: .   In patients with acute coronary syndromes (ACS) and planned PCI, the TRITON-TIMI 38 trial demonstrated that treatment with prasugrel compared with clopidogrel was associated with a reduced rate of cardiovascular death/MI/stroke and an increased risk of major bleeding.  We evaluated the cost-effectiveness of treatment with prasugrel vs. clopidogrel for the duration of the trial, from the perspective of the German healthcare system, based on data from TRITON-TIMI 38. METHODS: .  Detailed resource utilization data were collected for all patients from 8 countries (U.S.,Australia,Canada,Germany,Italy,Spain,UK and France; n=3373 prasugrel, n=3332 clopidogrel).  Hospitalization costs were estimated from the perspective of the German healthcare system on the basis of diagnosis-related groups (DRGs) for Germany and in-hospital complications.  Costs for cardiovascular medications were estimated using public price per tablet (clopidogrel=€2.68/day; prasugrel=€2.94/day).  Life expectancy (LE) was estimated based on in-trial cardiovascular and bleeding events, using statistical models developed from a similar population from the Saskatchewan Health Database.  Costs in added years of life were not included in the base case.  The analysis was carried out for the overall cohort and the 10mg. recommended population of patients with no history of stroke/TIA, age<75 and body wt.>= 60kg.  RESULTS: .  Over a median 14.5 month follow-up period, average total costs were €15/patient (€20/patient for the 10mg. recommended population) lower with prasugrel, due to a lower rate of rehospitalization involving PCI.    Prasugrel was associated with LE gains of 0.102 years (0.129 for the 10mg. recommended population), due primarily to the decreased rate of non-fatal MI.  Compared to clopidogrel, prasugrel was thus an economically dominant treatment strategy.  When compared to generic clopidogrel at a cost of =€1.80/day, there was an incremental net cost with prasugrel of €281/patient (€285/patient for the 10mg. recommended population), and an ICER of €2743/life year gained (€2213/life year gained for the 10mg. recommended population).  CONCLUSIONS: .  For ACS patients with planned PCI,  prasugrel for up to 15 months compared with current standard of care is an economically attractive treatment strategy.