OBJECTIVES: The multicentre, double-blind, randomized PLATO trial showed that treatment with ticagrelor + aspirin reduced the risk of myocardial infarction, stroke or death from vascular causes without a significant increase in major bleeding compared to clopidogrel + aspirin treatment in patients with ACS. The long-term cost-effectiveness is evaluated using a 12-month treatment period with ticagrelor versus clopidogrel in patients with ACS based on PLATO trial data from the Mexican public and private perspective. METHODS: The cost-effectiveness model is divided into two parts: a short-term decision tree based on data from the PLATO trial to estimate rates of cardiovascular events, healthcare costs, and health-related quality of life for the 12 months of therapy and a long-term Markov model to estimate quality-adjusted survival and costs conditional on whether a non-fatal MI, a non-fatal stroke or no MI or stroke occurred during the 12 months of therapy. Costs were calculated by applying 2010 Mexican unit costs. The daily drug price used was $2.05 and $4.91 for clopidogrel and ticagrelor, respectively. The estimated mean costs and QALYs are calculated over a lifetime time horizon and presented as incremental cost per QALY. Probabilistic sensitivity analyses were performed. RESULTS: Ticagrelor was associated with a QALY gain of 0.10; this was primarily driven by lower mortality and fewer non fatal MI’s resulting in an incremental cost per QALY gained of $7670 and $7073 for the public and private healthcare sector, respectively. Probabilistic sensitivity analysis indicated that ticagrelor has more than 99% probability of being more cost-effective than clopidogrel at a willingness to pay of $30,000 per QALY. The results were consistent in all ACS subgroups. CONCLUSIONS: Ticagrelor + aspirin is a cost effective treatment compared to clopidogrel + aspirin for one year treatment in ACS patients based on the PLATO trial and Mexican unit costs.