OBJECTIVES: The PLATO trial showed that in patients with acute coronary syndromes (ACS) treatment with ticagrelor plus acetylsalicylic acid (ASA) compared with clopidogrel/ASA significantly reduced the rate of myocardial infarction (MI), stroke, or death from vascular causes without a significant increase in the rate of overall major bleedings. The present study evaluates the long-term cost-effectiveness of treating patients with ticagrelor in Germany from the perspective of the Statutory Health Insurance (SHI). METHODS: : A two-part decision-analytic model, comprising a decision tree approach for the first year followed by a long-term Markov model, was constructed to estimate lifetime costs and life year gained (LYG) of treating ACS patients for one year with ticagrelor/ASA compared with clopidogrel/ASA. Data for the first year were derived from the PLATO trial. For the long-term model the German lifetable from the cause-of-death-statistics and selected conservative assumptions were utilized to extrapolate survival conditional on whether a non-fatal MI, a non-fatal stroke or no event occurred during the first year. Costs were based on official tariffs (e.g. DRGs) and published literature. For the base case daily cost of €2.99 was applied for ticagrelor. Daily cost for clopidogrel was applied in a range from €0.38 (lowest generic) to €2.44 (Plavix) with an average generic cost of €0.68 (base case). Extensive probabilistic, uni- and multivariate sensitivity analyses were performed. RESULTS: : Treatment with ticagrelor was associated with 0.16 LYG versus clopidogrel. The cost per LYG in the base case was €3,361. Overall the cost per LYG ranged from €-430 (dominant situation) to €4,077 compared with clopidogrel (Plavix vs. lowest generic). Results were consistent throughout the sensitivity analyses. CONCLUSIONS: Based on evidence from the PLATO study, treating a broad spectrum of ACS patients with ticagrelor for one year seems to offer a cost-effective option in the German health care setting compared with clopidogrel.