OBJECTIVES: The PLATO trial showed that ticagrelor reduced the risk of myocardial infarction, stroke or death from vascular causes compared to clopidogrel (hazard ratio 0.84, 95% CI 0.77 to 0.92) without a significant increase in major bleeding. The objective of this analysis is to evaluate direct and indirect costs of ticagrelor versus branded clopidogrel in patients with acute coronary syndromes (ACS) from a Russian health care perspective. METHODS: An excel based model was developed to estimate the direct and indirect cost per treatment arm for specific CV events (non fatal MIs, CV deaths and other deaths). Rates of non fatal myocardial infarction (MI), CV death and death from other causes was extracted from the PLATO trial (NCT00391872). Difference in direct medical and non-medical costs for ticagrelor vs clopidogrel in patients was estimated using the events above. One-way sensitivity analysis was performed. RESULTS: The result of this analysis shows that ticagrelor is associated with reduced healthcare costs compared with branded clopidogrel for one year treatment in a Russian healthcare setting. The incremental drug costs of ticagrelor (- 264.46 RUB (€6.48) per patient per year) was offset by higher non drug costs associated with fewer MI’s and deaths. Treatment with ticagrelor for one year is associated with total cost savings of 2749.97 RUB (€67.37) per patient, the direct cost savings was of 1260.83 (€30.89) and the indirect was 1489.13 RUB (€36.48) Sensitivity analysis showed that ticagrelor remains to be cost saving compared to branded clopidogrel as long as the ticagrelor price is less than 3520.94 RUB (€86.25) per package while keeping other model parameters unchanged. CONCLUSIONS: This analysis demonstrates that one year treatment with ticagrelor is less costly than branded clopidogrel for patients with  ACS from a Russian health care perspective.