OBJECTIVES: To evaluate the cost-effectiveness of a one-year treatment period with 90 mg twice daily Ticagrelor compared to 75 mg/day Clopidogrel in acute coronary syndrome (ACS) patients with or without ST-segment elevation from the third-party-payer perspective in Greece. METHODS: An existing model consisting of a one-year decision tree based on the PLATO trial data and a long-term extrapolation Markov model was adapted to the Greek health-care setting. Utility values obtained from the PLATO trial were used to estimate quality-adjusted life years (QALY) for both the decision tree and the Markov model. Local unit costs in combination with resource use data collected within the PLATO trial were used to estimate the costs incorporated in the analysis. These costs included treatment and medication costs, cost for the management of adverse events, hospitalization, outpatient visits, rehabilitation and nursing costs. Cost-effectiveness and cost-utility was expressed as the incremental cost per life year gained (LYG) and QALY gained (ICER), respectively. RESULTS: Implementing a lifetime horizon, the analysis predicts a discounted survival of 11.63 years in the Ticagrelor treatment group and 11.48 years in the Clopidogrel treatment group. The corresponding discounted QALYs were 9.78 and 9.65, respectively. The cumulative lifetime costs per patient were €24,967 and €24,170, for Ticagrelor and Clopidogrel treatment arm, respectively. The ICER was €5239 for each LYG and €6079 for each QALY saved. Implementing a 5-year horizon analysis, results in a discounted survival of 4.36 and 4.31 years for Ticagrelor and Clopidogrel treatment respectively. The QALYs and costs per patient were 3.77 and €15,239 for Ticagrelor and 3.73 and €14,604 for Clopidogrel. The ICER in this case was €12,631 for each LYG and €14,176 for each QALY saved. CONCLUSIONS: One-year treatment with Ticagrelor in addition to aspirin is a cost-effective treatment option vs Clopidogrel plus aspirin in patients with ACS in Greece.