OBJECTIVES: To evaluate the cost-effectiveness of trimetazidine (TMZ) as add-on therapy to standard-of-care (SoC) compared to SoC alone in patients with chronic stable angina who did not respond adequately to first line therapy with beta-blockers, nitrates or calcium channel antagonists, in Greece.  METHODS: A Markov model with monthly cycles and 1-year time horizon was developed to assess the comparators. The analysis was conducted from a third-party payer perspective. The clinical inputs and utility values were extracted from the published literature. Cost inputs considered in the model include anti-anginal drug-acquisition costs, hospitalization costs (with and without vascular interventions), and monitoring costs that encompass outpatient visits, laboratory and diagnostic tests. Resource consumption data were obtained from local experts, using a questionnaire developed for the purpose of the study. These were combined with unit cost data obtained from official sources. All costs reflect the year 2014. Cost effectiveness was assessed by calculating the incremental cost effectiveness ratio (ICER). Probabilistic sensitivity analysis (PSA) was performed to account for uncertainty and variation in the input parameters of the model.  RESULTS: The analysis showed that the cost of TMZ plus SoC was €1,055 versus €1,040 for SoC alone. In terms of health outcomes, TMZ plus SoC was associated with 0.617 QALYs versus 0.614 QALYs for SoC alone. The incremental analysis resulted in an ICER of €4,148 per QALY gained. PSA revealed that the probability of TMZ plus SoC being cost-effective compared with SoC was 95%, at a threshold of €34,000 per QALY gained (twice the average annual income).  CONCLUSIONS: The results indicate that TMZ as add–on treatment is a highly cost-effective option for the symptomatic treatment of patients with chronic stable angina in Greece when compared to SoC alone.