OBJECTIVES: Reasonability of vitamins В, Вand folic acid (FA) for the prevention of cardiovascular complications in patients with coronary heart disease (CHD) is debated. The aim of the study is to assess the cost effectiveness of homocysteine-lowering and standard therapy versus standard therapy in patients with CHD. METHODS: Results of the clinical randomized trial [O. O. Shakhmatova, A. Komarov, A. N. Samko et al. / Rational Pharmacotherapy in Cardiology, 2011; 7(2), 524-35]. Cost-effectiveness analysis of homocysteine-lowering therapy by vitamins В, Вand FA combined with the standard therapy versus the standard therapy (antiplatelet, statin, antihypertensive drugs: ACE inhibitors, beta-blockers) in patients with CHD and postPCI, with the elevated level of homocysteine affected by cyanocobalamin deficiency. The first level of costs, i.e. the cost of treatment, was taken into account. RESULTS: Two treatment regimens were analyzed: the first regimen “vitamins + standard”: patients (n=97) of which since the randomization received FA (0.6 mg/day), vitamin В (4 mg/day) and vitamin В (10 µg/day) along with the standard treatment. Patients in the control group (n=167) received only standard therapy. The observation period was 20 months. The first regimen “vitamins + standard” contributed to reduction of the total combined outcome: cardiovascular death, acute coronary syndrome, stroke, revascularization by 95.0%, standard therapy – by 65.7%. The costs amounted to € 371 for the regimen “vitamins + standard” and € 271 for the standard therapy, respectively. The “cost-effectiveness” ratio have showed that the treatment regimen “vitamins + standard” is more cost effective, its use compared to the standard therapy requires additional expenses in the amount of € 307.17 for 1 additional  prevented event that did not occurred.  CONCLUSIONS: Homocysteine-lowering therapy combined with the standard therapy of patients with CHD with В deficiency is clinically more effective and more cost effective compared to the standard therapy.