OBJECTIVES: To conduct an economic evaluation comparing ranolazine plus  standard-of-care (SoC) relative to SoC alone, in patients with chronic stable angina who did not respond adequately to first line therapy, in Greece.  METHODS: A decision tree model was locally adapted in the Greek setting to evaluate the cost-utility of comparators during a 6-month period. The analysis was conducted from a payer (sickness fund) perspective. The clinical inputs were extracted from the published literature. The cost inputs considered reflect drug acquisition, hospitalizations, vascular interventions and monitoring of patients. Resource utilization data were obtained from 3 local experts. All costs refer to the year 2014. Cost-effectiveness was assessed by means of the incremental cost per quality adjusted life year (QALY) saved with the ranolazine as add-on therapy, relative to SoC alone (ICER). Probabilistic sensitivity analysis (PSA) was performed.  RESULTS: Ranolazine as add-on therapy was more costly compared to SoC alone, as the 6-month total cost per patient was €1,170 and € 984, respectively. Patients received ranolazine plus SoC and SoC alone gained 0.3155 QALYs and 0.2752 QALYs, respectively. Hence, ranolazine plus SoC resulted in an ICER of €4,620 per QALY gained, well below the threshold of €34,000 per QALY gained, that is twice the annual per capita income. The PSA showed that the likelihood of ranolazine plus SoC being cost-effective at the threshold of €34,000 per QALY gained was 100%.   CONCLUSIONS: Τhe results suggest that ranolazine as add–on treatment may be a cost-effective alternative for the symptomatic treatment of patients with chronic stable angina in Greece.