OBJECTIVES: Statins reduce the risk of cardiovascular events in patients with diabetes. The aim of this study is to determine whether statin treatment for primary prevention in newly diagnosed type 2 diabetes is cost-effective, taking non-adherence, baseline risk, and age into account. METHODS: A cost-effectiveness analysis was performed using a Markov model with a time horizon of 10 years. The baseline 10-year cardiovascular risk was estimated in a Dutch population of primary prevention patients with newly diagnosed diabetes from the Groningen Initiative to Analyse Type 2 Diabetes Treatment database (GIANTT), using the UKPDS risk engine. Statin adherence was measured as pill days covered (PDC) in the IADB.nl pharmacy research database. Cost-effectiveness was measured in costs per quality-adjusted life-year (QALY) form the healthcare-payers’ perspective. RESULTS: For an average patient aged 60 at diagnosis, statin treatment was highly cost-effective at around €2,300 per QALY. Favourable cost-effectiveness was robust in sensitivity analysis. Differences in age and 10-year cardiovascular risk showed large differences in cost-effectiveness from more than €100,000 per QALY to almost being cost saving. For the average patient aged 40 at diabetes diagnosis, statin treatment for primary prevention was not cost-effective. CONCLUSIONS: Despite the non-adherence levels observed in actual practice, statin treatment is cost-effective for primary prevention in patients newly diagnosed with type 2 diabetes. Due to large differences in cost-effectiveness according to different risk and age groups, the efficiency of the treatment could be increased by targeting patients with relatively higher cardiovascular risk and higher ages.