OBJECTIVES: To assess long-term cost-effectiveness of various doses of rosuvastatin (R) versus relevant doses of generic atorvastatin (A) (R20 mg versus A40 mg (primary comparison), R10 versus A20 and; R40 versus A80) in patients with a high risk of CV events (10-year Framingham CVD risk ≥ 20%). METHODS: A Monte Carlo simulation model was developed based on JUPITER (Justification for the Use of statins in Primary prevention: an Intervention Trial evaluating Rosuvastatin, NCT00239681) trial findings and modeled cardiovascular events and death over the lifetime of patients. The relative efficacy of the A20, A40, A80, R10, and R40 mg compared to R20 mg (as observed in JUPITER) were estimated by computing relative 10-year Framingham cardiovascular event risks based on reported differences in Total Cholesterol/High-Density Lipoprotein cholesterol ratio. Epidemiological data specific for the Swedish setting were utilized to model mortality. Incremental effectiveness was primarily measured as quality-adjusted life-years (QALYs) gained. Cost-effectiveness was assessed based upon direct costs. All effects and costs (2008/09 Swedish unit prices) were discounted at annual 3%. An 80% price reduction was assumed for generic versus branded statin. RESULTS: The model estimated that treating a cohort of 100,000 patients (66 years, 60% males) with R20 avoided 1121 CVD events over lifetime compared with atorvastatin 40 mg. This translated into an estimated gain of 4090 years in full health (QALYs). The estimated incremental cost per QALY gained was SEK366,763 (€37,273). This estimate was SEK428,060 (€43,502) for R10 versus A20, and SEK582,241 (€59,171) for R40 versus A80. Probabilistic sensitivity analyses supported base case results. CONCLUSIONS: Treatment with rosuvastatin 10 mg, 20 mg and 40 mg is cost-effective compared with relevant doses of generic atorvastatin (20 mg, 40 mg, 80 mg, respectively) for the primary prevention of cardiovascular events for patients with high baseline cardiovascular risk (10-year Framingham CVD risk ≥ 20%) in Sweden.