OBJECTIVES: This study assessed the long-term cost-effectiveness of rosuvastatin 10 mg therapy in reducing the incidence of major cardiovascular disease (CVD) events and mortality in patients at higher risk of CVD events (Framingham risk  ≥10%). METHODS: A probabilistic Monte Carlo simulation model estimated long-term cost-effectiveness of rosuvastatin therapy (10 mg daily) for the prevention of CVD mortality and morbidity in patients with Framingham 10-year CVD risk >10%.  The model was developed based on the JUPITER (Justification for the Use of statins in Primary prevention: an Intervention Trial evaluating Rosuvastatin) trial findings and includes modeling of initial and subsequent CVD events and death over time. Using rosuvastatin 20 mg efficacy findings from the JUPITER trial, efficacy of rosuvastatin 10 mg was estimated using the Framingham equation based on effects on total cholesterol/high-density lipoprotein cholesterol ratio.  The quarterly event probabilities were used to construct survival curves for patients in both the treatment and placebo groups, and the relative risk of rosuvastatin was estimated and extrapolated beyond the trial duration.    A payer perspective was used with direct medical costs, and 10-year, 20-year and lifetime horizon. RESULTS: For a hypothetical cohort of 100,000 patients (age 65 years, 60% men) at moderate or high risk of CVD events (Framingham risk ≥10%), estimated quality-adjusted life-years (QALYs) gained with rosuvastatin therapy, compared with placebo, was 31,079 over a lifetime horizon, and 22,598 and 8,580 over 20- and 10-year horizons, respectively. Rosuvastatin 10 mg treatment avoided approximately 11,044 events over the lifetime (5,665 non-fatal MIs, 2,741 non-fatal strokes, and 3,448 CVD deaths avoided).  Estimated incremental cost-effectiveness ratio (ICER) for cost per QALY was $7,974 (lifetime), $12,865 (20-year horizon), and $53,101 (10-year horizon). CONCLUSIONS: Study results indicate rosuvastatin 10 mg treatment to be a cost-effective treatment alternative in patients at a higher risk of CVD events.