OBJECTIVES: In the PLATO study, ticagrelor significantly reduced the rate of myocardial infarction (MI), stroke, or death from vascular causes without a significant increase in the rate of overall major bleeding compared to Clopidogrel in the management of acute coronary syndrome (ACS) patients. We aimed to assess the long term cost-effectiveness of ticagrelor versus clopidogrel in the management of ACS patients in Hong Kong. METHODS: A Markov decision analytic model was used to perform a cost-effectiveness analysis (CEA) of treating ACS patients for one year with ticagrelor plus aspirin (group 1) compared with clopidogrel plus aspirin (group 2) from the Hong Kong healthcare provider perspective. The model simulates a cohort of 45-year-old patients with ACS moving between different health status in each Markov cycle of 1 year. The time horizon was lifetime (85 years old). Health states included patient in ACS without event, myocardial infarction (MI), and death from vascular cause. Outcome measures included lifetime costs, quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratios (ICERs). Event rates of group 1 are adopted from the PLATO study and rates of group 2 from the Prince of Wales Hospital ACS Registry in Hong Kong. Probabilistic sensitivity analyses using Monte Carlo simulations were conducted to assess parameter uncertainty. RESULTS: The ICER for ticagrelor compared to clopidogrel in the treatment of ACS was HK$34,441 (US$4,415) per QALY gained. For the subset of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation ACS (NSTEACS), the ICERs per QALY gained were HK$ 33,402 (US$4,282) and HK$ 38,844 (4,980) respectively. Ticagrelor treatment strategy was cost-effective over 99% of the Monte Carlo simulation using a cost-effectiveness threshold of <3 times gross domestic product (GDP) per capita in Hong Kong. CONCLUSIONS: The treatment of ACS patients with ticagrelor for 12 months is considered cost-effective compared with clopidogrel from a healthcare provider perspective.