OBJECTIVES: To estimate the costs of acute coronary syndrome in Brazil and its impact on the Brazilian healthcare system, considering direct and indirect cost under the public and private perspectives to support further HTA incorporation. METHODS: In this study we adopted the societal perspective, including the public (SUS) and supplementary (SHS) healthcare system perspectives. Direct costs were retrieved from national databases1 and only hospitalization period was considered. For indirect costs the Human Capital Approach method was used with two major costs included in the analysis: loss of productivity among patients that died of a MI or unstable angina event and the loss of productivity of the period between the main event (MI or angina) and the return to work (recovery time). For the study we assumed the age from 25 to 64 years old as active labor age (65 is the age of retirement in Brazil), a recovery time of 3.4 months and the average income of the population to estimate the loss of productivity for each working month lost. RESULTS: The estimated direct costs associated to Acute Coronary Syndrome for 2011 under the SUS perspective is  US$ 314,080,370 and for SHS it is US$ 309,781,809. The estimated indirect cost for 2011 is US$ 1,703,908,984. So, the total estimated costs for ACS in Brazil for 2011 is US$ 2,327,771,163. CONCLUSIONS: Due the high impact of ACS costs for the Brazilian healthcare system (U$ 2,327,771,163.11), projected for the year of 2011, it is very relevant to evaluate measures that can reduce such events beyond those already in use.