OBJECTIVES: To assess the cost-effectiveness of rosuvastatin 20 mg for prevention of major cardiovascular disease (CVD) events and mortality compared with no treatment alternative in a higher CVD risk population based on findings from JUPITER (Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin). METHODS: A probabilistic Monte Carlo simulation model estimated long-term cost-effectiveness of rosuvastatin therapy (20 mg daily) for the prevention of CVD mortality and morbidity. Using outcomes data from the JUPITER trial, the relative risk reduction of rosuvastatin 20 mg compared with no treatment was carried forward beyond the trial period. Baseline CVD event risk was age adjusted using Framingham equation. Cost- effectiveness was assessed from a payer perspective using direct medical costs and a lifetime horizon. Life tables and CVD-attributable mortality risk estimates were derived from Mexican national statistics data. Results are presented in U.S. dollars (exchange rate 13 MXN/dollar). RESULTS: The model was run for a hypothetical cohort of 100,000 patients at higher risk of CVD events (men 61%, age 67 years, mean Framingham risk 15%). Estimated quality adjusted life years (QALYs) gained with rosuvastatin therapy compared with no treatment was 31,723 over lifetime and 23,946 over a 20-year horizon. Over lifetime, 11,680 events were avoided: 6,076 non-fatal MIs, 2,596 non-fatal strokes, and 3,729 CVD deaths. The estimated incremental cost-effectiveness ratio (ICER) for cost per QALY was $8,91 for a lifetime horizon. For a hypothetical cohort similar to the overall JUPITER population, the ICER was $11,764/QALY over lifetime.  For a 20-year horizon, similar ICERs were estimated for the higher-risk ($11,327/QALY) and JUPITER patient populations ($16,279/QALY).   CONCLUSIONS: In a higher-risk Mexican population with the mean Framingham risk of 15%, treatment with rosuvastatin 20 mg daily is a cost-effective treatment alternative if the willingness to pay per QALY is higher than $8291.