OBJECTIVES  Ticagrelor (TG) is a new oral platelet inhibitor with improved therapeutic effect and safety profile than clopidogrel. Yet it is not listed in the public hospital formulary of Hong Kong, hence suitable patients do not have general access to it. A budget impact analysis would thus help provide evidence to assist local budget holders in decision making processes. METHODS  A budget impact model was built to allow assessment of the budgetary impact to the local health care system from a government perspective if TG is introduced into the local market. The scenarios adopted were world with and without TG. A hypothetical cohort of 16,000 patients with acute coronary syndrome (ACS) was used as the population. Proportion of ACS events was estimated using HK-specific values. Sources of drug and DRGs costs were from the local public hospital authority as released in 2011. Market shares of TG as compared to clopidogrel (branded) for world without and with TG over a 5-year period were assumed to be 0% and 10-25% (with 5% increment/year) respectively. RESULTS Over a 5-year period, the budget impact of using TG was estimated to range from 1.18% (year-1) to 3.21% (year-5) if TG was introduced. The actual extra cost per patient was estimated to range from HKD423 (USD54, 1USD=7.8HKD) in year-1 to HKD1,135 (USD146) in year-5. Deterministic sensitivity analysis performed suggested that proportions of bleeding between the 2 drugs and drug cost are the most influential variables. The drug acqusition costs were partially offset by improved therapetic outcomes, reduction in side effects and shortened hospital stay. CONCLUSIONS  Results of the present budget impact analysis suggest that introducing TG into the market of Hong Kong would only have minimal effect on the health care budget. Budget holders should consider TG as an option to clopidogrel in view of its better therapeutic effects and safety profile.