OBJECTIVES: This study was conducted to compare health and cost outcomes utilizing either Ticagrelor versus Plavix in the management of acute coronary syndrome (ACS) patients, and impact of generic Clopidogrel used in Hong Kong. METHODS: A decision analytic model was used to perform a cost-effectiveness analysis of treating ACS patients for one year with Ticagrelor plus aspirin strategy compared with Plavix (or generic Clopidogrel) plus aspirin strategy from Hong Kong healthcare provider perspective. To estimate discounted (3%) lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). The health states in the model included patient in ACS without event, myocardial infarction (MI), and death from vascular cause. The model simulates a cohort of 45-year-old patients with ACS, and Markov cycle is one year. The time horizon was lifetime (85 years old). Event rates were adopted from the PLATO study, and the ACS registry in the Prince of Wales Hospital (PWH) in Hong Kong. Probabilistic sensitivity analyses using Monte Carlo simulations were conducted to assess parameter uncertainty. RESULTS: Compared with the Plavix (or generic Clopidogrel) treatment strategy, the Ticagrelor treatment strategy for ACS, STEMI, and UA / NSTEMI patients were associated with ICERs of HK$ 34,441(35,304), HK$ 32,753(33,567), HK$ 39,343(40,417) (1US$ = 7.8HK$) per QALY gained, respectively. Ticagrelor treatment strategy was cost-effective over 99% of the Monte Carlo simulation using a cost-effectiveness threshold of < 1x GDP per capita of Hong Kong. CONCLUSIONS: The Ticagrelor strategy is considered cost-effective at three times per capita GDP threshold compared with Plavix or generic Clopidogrel strategy in the management of ACS patients in Hong Kong. The impact of ICER values of generic clopidogrel compared with Plavix is not significant even the sextuple cost in Hong Kong.