OBJECTIVES: A randomized phase-III clinical trial (PLATO) showed that a 1-year dual antiplatelet treatment with ticagrelor and aspirin (ASA) reduced the composite endpoint of cardiovascular death, myocardial infarction (MI), and stroke without an increase in major bleedings compared to the combination clopidogrel-ASA in patients with acute coronary syndromes (ACS). Using a model based on the PLATO outcomes, we assessed the cost-effectiveness of ticagrelor-ASA vs. clopidogrel-ASA in ACS patients in Belgium.   METHODS: The model developed in TreeAge combined a decision tree for the first year of treatment and a Markov model with a lifelong time horizon using 1 year cycles. First year probabilities of events (cardiovascular death, MI, strokes, bleedings) were derived from the PLATO study. In subsequent years, transition probabilities between health states (event-free, post-MI, post-stroke, death) were obtained from a previously published HTA-model on clopidogrel-ASA in ACS. Utility data was provided by literature. Cost data was obtained from published articles and from the IMS Hospital Disease Database,. The incremental cost-effectiveness ratio (ICER) of ticagrelor vs. generic clopidogrel was calculated in terms of cost per quality-adjusted life-year (QALY) gained over a lifetime horizon from the Belgian payer perspective and evaluated against the lower WHO threshold based on 1 time the Gross Domestic Product for Belgium (around 30,000€/QALY). Annual discounting rates of 3% and 1.5% were applied on costs and effects respectively.  RESULTS: Ticagrelor-ASA was associated with an incremental cost of €816.9 and 0.079 added QALY’s (primarily driven by a reduction in MI and mortality). The ICER was 10,316€/QALY. The cost per life year gained was 6,965€. The ICERs were consistent in subgroups of patients treated invasively or not. Probabilistic sensitivity analysis showed that the ICER remained below 30,000€/QALY in 98.8% of cases (also in subgroups).  CONCLUSIONS: Dual antiplatelet treatment with ticagrelor-ASA can be considered cost-effective compared to clopidogrel-ASA.