OBJECTIVES: The PLATO trial was a multicentre, double-blind, randomized trial comparing clopidogrel + aspirin and ticagrelor + aspirin for treatment of patients with ST-elevation and non-ST-elevation acute coronary syndromes (ACS). The results showed a significant reduction for ticagrelor in the primary composite endpoint – cardiovascular deaths, myocardial infarction, or stroke - without a significant increase in major bleeding. Based on PLATO trial data long-term cost-effectiveness was evaluated for 12-month treatment with ticagrelor versus clopidogrel in patients with ACS, from the Brazilian public health care perspective. METHODS: For the analysis of cost-effectiveness a two-part cost-effectiveness model was used. The first part was a 12-month decision tree using PLATO trial data to estimate rates of cardiovascular events, healthcare costs, and health-related quality of life for the 12 months of therapy. The second part was a long-term Markov model estimating quality-adjusted survival and costs conditional on whether a non-fatal MI, a non-fatal stroke, or no MI or stroke occurred during the 12 months treatment. The model applied a lifetime horizon to calculate mean costs and QALYs. The results are presented as incremental cost-effectiveness ratios (ICER’s). Daily costs of $1.62 for generic clopidogrel and $4.58 for ticagrelor were applied. Other costs were calculated by applying Brazilian year 2010 unit costs. Probabilistic sensitivity analysis was performed. RESULTS: Ticagrelor was associated with a QALY gain of 0.10, primarily driven by lower cardiovascular mortality. The resulting incremental cost per QALY gained was $8966 in the public sector. Probabilistic sensitivity analysis indicated that ticagrelor had more than 99% probability of being cost-effective at a willingness to pay of $30,000 per QALY. The results were consistent in all analyzed subgroups. CONCLUSIONS: Based on the PLATO trial data one year treatment with ticagrelor + aspirin versus clopidogrel + aspirin in ACS patients is cost-effective from a Brazilian public health care perspective.