OBJECTIVES: The CURE study has demonstrated that clopidogrel on top of standard therapy (including aspirin, ASA) decreases the risk of cardiovascular death, myocardial infarction and stroke by 20% in patients with acute coronary syndromes without ST- elevation. The objective of this study was to evaluate the cost-effectiveness of adding clopidogrel to standard treatment in the Netherlands. METHODS: The cost-effectiveness, in terms of costs per saved life-year, was determined with a Markov model in which patients were divided according to vascular events and time from last event. Effectiveness data were derived from the CURE study; long-term outcomes were based on epidemiological estimates concerning age specific event rates and case fatality rates. Quality of life estimates were obtained from the literature. Direct costs were updated from previous studies, indirect costs were disregarded due to the age of the patients. RESULTS: The number needed to treat with clopidogrel for one year to prevent one event was 35. The annual cost of treatment was €20.355 in patients treated with clopidogrel on top of standard therapy (including ASA) and €20.342 in patients in the control group (standard therapy including ASA). After discounting costs and effects at 4%, treatment with clopidogrel resulted in annual cost saving of €17 per patient. There was also a gain in life-years and quality adjusted life years (QUALY's) of 0.122 year and 0.137 QALY's per patient. Multivariate sensitivity analyses revealed that the results are robust. CONCLUSIONS: Clopidogrel is highly cost-effective when added to standard treatment, including ASA, in patients with acute coronary syndromes without ST-elevation.