Acute coronary syndromes account worldwide for a significant burden of hospital- and societal costs. Pharmacotherapy of acute coronary syndromes consists of a combined antithrombotic therapy. Remarkable therapeutic advances have been made with the introduction of glycoprotein IIb/IIIa receptor inhibitors, low molecular weight heparins and thienopyridines, such as clopidogrel. Based on positive clinical data of large randomized trials numerous cost studies have been undertaken to analyse the cost-effectiveness of these new drugs. Most of them are showing an acceptable level of cost-effectiveness for the new treatments. Taking all available cost-studies into account, we conclude that new antithrombotic treatments are cost-effective as long as their use is limited to selected patient populations.