Clopidogrel has been shown to reduce the secondary risk of ischaemic events in vascular disease compared to aspirin. This article compares the economics of the two drugs for this condition, by providing an incremental cost-effectiveness ratio (iCER) of clopidogrel versus aspirin, using Belgium as a case setting.A 2 year Markov model, in which patients with vascular disease were assumed to receive either clopidogrel or aspirin, was developed from a healthcare payer's perspective. Survival data were based on the Saskatchewan Health database. Costs included treatment and adverse events.Cost-effectiveness was expressed as the cost per life year gained (LYG).The iCER of clopidogrel versus aspirin was a13,390/LYG (95% CI: a6,990; a26,470).The robustness of these results was shown by univariate and probabilistic sensitivity analyses.This analysis shows that clopidogrel is cost-effective for the secondary prevention of ischaemic events in the Belgian setting.