OBJECTIVES: To assess cost-effectiveness of  fondaparinux versus enoxaparin in patients with non-ST-elevation acute coronary syndrome  in Russia. METHODS: A decision tree model was created incorporating the outcomes associated with 2 antithrombotic approaches from OASIS-5 trial: enoxaparin (1 mg/kg every 12 hours) versus fondaparinux (2.5 mg/day). Probabilities of complications (e.g., myocardial infarction, stroke, major bleeding at 9, 30 and 180 days) were calculated. Data on resource utilization (staff, drugs, materials, laboratory, and equipment), diagnosis and treatment came from the hospital survey. Resources were valued in internal hospital prices based on obligatory medical insurance tariffs (as of  2008). The incremental cost-effectiveness ratio for fondaparinux per death avoided and per major bleeding episode avoided versus enoxaparin was  quantified. Sensitivity analysis was performed. RESULTS: The cost analysis showed that fondaparinux would generate a cost saving  of  1634 RUR (€43), 1902 RUR (€50) and 2167 RUR (€57) per patient at 9, 30 and 180 days respectively. When cost and clinical results were extrapolated to cost-effectiveness,  fondaparinux was dominant (less costly and more effective in terms of death avoided and major bleeding episode avoided). The sensitivity analysis proved that costs of pharmacotherapy with fondaparinux and enoxaparin had the biggest impact on results. CONCLUSIONS: Fondaparinux is a more cost-effective option than enoxaparin in treatment of patients with non-ST-elevation acute coronary syndrome  from the hospital perspective in Russia.