OBJECTIVES:  To assess the budget impact of the use of ticagrelor combined with acetylsalicylic acid (ASA) in comparison withclopidogrel plus ASA in patients with acute coronary syndrome (ACS) managed with coronary artery bypass grafting (CABG) from societal perspective in Russia. METHODS:  Clinical effectiveness of the therapeutic alternatives under evaluation was comparedby subanalysis,which includes ACS patients, managed with CABG, from randomized controlled trial PLATO. Direct medical expenses on antiplatelet therapy with ticagrelor plus ASA and original clopidogrel plus ASA during one year and management of patients dying from cardiovascular and other causes, as well as indirect expenses due to gross domestic product loss in case of premature death were included in the analysis. In budget impact model only for indirect cost discount rate 3% was applied. RESULTS:  Both cost of one-year antiplatelet therapy (39 145 rubles per patient for ticagrelor plus ASA vs. 29 193 rubles for clopidogrel plus ASA) and direct medical expenses (40 624 rubles per patient for ticagrelor plus ASA vs. 32 088 rubles for clopidogrel plus ASA) were higher in case of therapy with ticagrelor plus ASA. Meantime, due to markedly lower total mortality (5.1% for ticagrelor plus ASA vs. 9.9% for clopidogrel plus ASA) indirect expenses (100 810 rubles per patient for ticagrelor plus ASA vs. 208 584 rubles for clopidogrel plus ASA) and total expenses (141 434 rubles per patient for ticagrelor plus ASA vs. 240 672 rubles for clopidogrel plus ASA) were lower for therapy with ticagrelor plus ASA. CONCLUSIONS: Despite higher medical expenses total cost of care for ACS patient managed with CABG in conditions of Russian health care system is lower in case of therapy with ticagrelor combined with ASA as compared to clopidogrel combined with ASA.