Objective: In this study, cost-effectiveness of different doses of Atorvastatin, Pravastatin, Rosuvastatin and Simvastatin are compared. The results are used to evaluate if prescription decisions follow willingness to pay. Methods: Incremental cost-effectiveness ratios (ICERs) were calculated using a model to be published in Value in Health. However, for this analysis, we used efficacy estimates from a meta-analysis that compared several statins across dose ranges. Furthermore, we considered two scenarios. In scenario 1, doses are doubled after 12 weeks of treatment if the LDL level is over 115 mg/dL; in scenario 2, the dose is fixed. For the analysis of prescription patterns and costs per dose, we used official data. Results: Results show that, in both scenarios, Pravastatin 10mg and 20mg and Atorvastatin 10mg are dominated. Taking Simvastatin 10mg as reference, the ICER of Simvastatin 20mg in scenario 1 is €203,780 and the ICER of Rosuvastatin 10mg is €108,293, while the ICER of Rosuvastatin 10mg compared to Simvastatin 20mg is €61,670. In scenario 2, the ICERs of Simvastatin 20mg and Rosuvastatin 10mg are €199.933 and €61.238, respectively, while Rosuvastatin 10mg dominates Simvastatin 20mg. In both cases the Simvastatin 20mg ICER is well above the €50.000 per life year gained threshold. However, Simvastatin 20mg is the most prescribed alternative in Portugal. In fact, during 2006 its market share was around 66%, while Simvastatin 10mg accounted just for 2% and Rosuvastatin 10mg for 12%. Future research will show how results change with the market launch of Rosuvastatin 5mg. Conclusion: Doctors are not influenced by economic evaluation when prescribing statins. Results show that Simvastatin 10mg should be used as first line and Rosuvastatin 10mg as second line strategies. Most probably, the high market share of Simvastatin 20mg reflects the “first mover” advantage in the market.