OBJECTIVES: To assess the health and budget impact  of increasing use of rosuvastatin in patients with high cardiovascular risk, while maintaining the overall level of use, upon the entry of generic atorvastatin in Sweden. METHODS: A model was developed to estimate the budget impact associated with changed statin utilization pattern in different risk groups. The Framingham Risk equation was used to estimate cardiovascular events, and the relative risk reduction for statins was modeled using the JUPITER (Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin) trial. A similar relative risk reduction was used for primary and secondary prevention settings based on available literature. Baseline risk distribution was derived from the Malmö Primary Prevention Study.  The use of rosuvastatin was assumed to increase from 4% (2011) to 7% (2014) in the high-risk group (27% baseline 10-year Framingham risk), but the overall use was kept unchanged (4%). A gradual atorvastatin use increase was assumed with a corresponding decrease in simvastatin use over 3 years. Cost calculations were from Swedish public health sources. Generic price for atorvastatin was assumed to be 5% of branded price. RESULTS: For the Swedish population on statin treatment (810,304 patients, 25% with a previous history of CVD) the estimated budget impact decreased by SEK 359 millions in 2012 (compared with 2011) and by SEK 441 millions in 2014 with changed statin utilization. The estimated number of CVD events avoided ranged from 98 in 2012 to 197 in 2014 compared with current year (0.81% decrease over the 3-year period). CONCLUSIONS: A shift to generic atorvastatin in 2012, accompanied by increased use of rosuvastatin in high-risk patients whilst maintaining rosuvastatin overall use at current levels, was estimated to prevent more cardiovascular events and resulted in overall healthcare budget savings for the 3-year period in Sweden.