OBJECTIVES: To conduct a systematic review on the pharmacoeconomic value of ranolazine vs standard-of-care (SOC) for the treatment of symptomatic chronic stable angina (CSA). METHODS: Medline, Cochrane Library and Cost-Effectiveness Analysis Registry without time limits were searched. Articles in English were identified with the following keywords: cost, economic, ranolazine, ranexa, angina, coronary artery disease. The identified studies were independently reviewed by two investigators against pre-determined inclusion and exclusion criteria. The Quality of Health Economic Studies scale was used to assess the quality of the included studies. The data of selected studies were extracted onto a data extraction form and consequently were synthesized. Costing and effectiveness data for each comparator, incremental cost per quality-adjusted-life year (QALY) gained and results from sensitivity analyses were extracted. RESULTS: Five studies containing evidence on effectiveness and cost of ranolazine were included in the review. Four of these studies assessed the cost–utility of ranolazine added to SOC compared to SOC alone, using decision tree or Markov models whereas one was a retrospective cost–comparative study. In all studies, patients were stratified according to their angina frequency symptoms. The analysis was conducted from a payer perspective in 4 studies and from the societal perspective in 1 study. The time horizon of analysis did not exceed the 1 year at any study. Ranolazine appeared to be cost-effective since it reduced the number of angina-related hospitalizations and improved quality of life with an Incremental Cost–Effectiveness Ratio (ICER) varying from €4,000 to €15,000 per QALY gained. The ranolazine acquisition cost was the variable that mainly drove the ICER. CONCLUSIONS: The existing evidence showed that ranolazine is cost–effective for the second–line treatment of patients with symptomatic CSA, added to SOC. Further research is required to evaluate the cost – effectiveness of ranolazine in each angina frequency group.