OBJECTIVES: Compare the cost-effectiveness of rosuvastatin versus standard management according to Framingham risk for the primary prevention of vascular events in JUPITER-like patients that had LDL levels less than 130 mg/dL and CRP levels of 2.0 mg/L or higher. METHODS: TreeAge Pro 2009 software was used to design 2 Markov-type models from a third party payer perspective to calculate the incremental cost-effectiveness ratio (ICER) of rosuvastatin 20 mg versus standard management over 10 years in patients with a Framingham Risk Score greater than 10% and less than or equal to 10%. Cost data were obtained from CMS and the Redbook. Quality of life measures were obtained from the literature. Event data were obtained directly from the JUPITER Study Group. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted on many possible ranges of cost, quality of life measures, and event rates. RESULTS: Treating patients with rosuvastatin to prevent vascular events would result in an estimated ICER of $37,232/QALY and $95,000/QALY in those with Framingham Risk Scores greater than 10%, and less than or equal to 10%, respectively. Results of 1-way sensitivity analysis were especially sensitive to the price of the rosuvastatin and the probability of a primary endpoint event in the standard management group. Results of a probabilistic sensitivity analysis suggest that in patients with a Framingham score greater than 10%, the probability that rosuvastatin would be considered cost-effective at a $50,000/QALY threshold is approximately 97.5%. In those patients with a Framingham Risk Score less than or equal to 10%, the probability that rosuvastatin would be considered cost-effective is less than 1%. CONCLUSIONS: Compared with standard management practices, statin therapy with rosuvastatin may be a cost-effective strategy over a 10-year time horizon for preventing vascular events in patients with a Framingham Risk Score greater than 10% that have normal LDL levels and elevated CRP levels.