OBJECTIVE: The CURE trial established that adding clopidogrel to standard therapy (including aspirin) provides a 20% relative risk reduction in the composite outcome of cardiovascular death, myocardial infarction and stroke in patients with acute coronary syndromes (ACS). The purpose of this analysis was to assess the long-term cost-effectiveness of adding clopidogrel to aspirin in Taiwan using the CURE trial results. METHODS: A cost-effectiveness analysis was conducted from the societal perspective and incremental cost-effectiveness ratios (ICER) were estimated using a long-term Markov model. Outcomes data were derived from the CURE trial and resource use data were collected locally: hospital costs and length of stays (LOS) were obtained from the inpatient expenditure by admissions claimed in the Bureau of National Health Insurance (BNHI) database between 1999 and 2001; drug costs were obtained from the Taiwan Pharmaceutical Benefit Scheme (2000); and indirect costs were estimated by multiplying the LOS (days) by the mean daily Taiwanese salary obtained from the Taiwanese government. Cost-effectiveness was expressed in terms of costs (New Taiwanese Dollars) per life-year gained (LYG). (1Euro≈NTD39.5). RESULTS: The base-case model resulted in a longer survival in the clopidogrel on top of aspirin strategy compared to the aspirin alone strategy (9.77 LYG vs. 9.65LYG; incremental LYG=0.117). The model also yielded higher direct costs (NTD252,011 vs. NTD248,344; incremental cost=NTD3,666) and lower indirect costs for the clopidogrel on top of aspirin strategy (NTD1,011 vs. NTD1,264; incremental cost=-NTD253). The resulting total ICER for the clopidogrel on top of aspirin strategy was 29,133NTD/LYG (≈ 737 Euros). This estimate is comparatively lower than estimates from Sweden (1,365Euros/LYG for direct costs). CONCLUSIONS: This model indicated that adding clopidogrel to standard therapy in patients with ACS results in a favorable cost-effectiveness ratio in Taiwan.