OBJECTIVES: To determine if there were differences between statins in terms of cardiovascular event rate and total cost among those who initiate therapy in a large managed care population. METHODS: Pharmacy and medical claims data were used from 14 geographically diverse health plans in the US covering approximately 14 million members. Members had at least one pharmacy claim for atorvastatin, rosuvastatin, simvastatin, simvastatin/ezetimibe, pravastatin, or lovastatin during the period between January 1, 2007 and December 31, 2008. Members who initiated therapy were followed for 36 months. Patients were stratified into either primary or secondary prevention. Outcomes included cardiovascular event rate and total adjusted cost. Multiple regression models were used to examine the association between statin therapy and cardiovascular event rate or healthcare cost while controlling for demographics and observable clinical characteristics. RESULTS: A total of 31,224 members were included, of which 25,055 and 6,169 were identified as primary and secondary prevention, respectively.  Adjusted odds ratios for cardiovascular event rates were not significantly different among the statins in either cohort. In the primary prevention cohort, total adjusted cost was lowest for simvastatin ($13,166), followed by lovastatin ($13,394), pravastatin ($13,811), atorvastatin ($18,209), rosuvastatin ($19,194), and simvastatin/ezetimibe ($19,254); overall p<0.0001. In the secondary prevention cohort, total adjusted cost was lowest for simvastatin ($25,111) followed by lovastatin ($27,246), pravastatin ($27,282), simvastatin/ezetimibe ($30,412), atorvastatin ($30,872), and rosuvastatin ($33,295); overall p<0.0001. In the primary prevention cohort, adjusted pharmacy cost was lowest for lovastatin ($4,417), followed by simvastatin ($4,420), pravastatin ($4,715), atorvastatin ($8,210), simvastatin/ezetimibe ($9,204), and rosuvastatin ($9,276); overall p<0.0001. Similar pharmacy cost patterns were observed in the secondary prevention cohort. CONCLUSIONS: There appears to be similar rates of cardiovascular events among the statins. Branded statins were generally associated with higher total cost compared to generic statins, likely driven by differences in pharmacy cost.