OBJECTIVES: The objective of this research was to examine differences in patterns of statin prescribingbetween Northern Ireland and England both before and after the introduction of the Quality and Outcomes Framework (QOF) METHODS: Northern Ireland practices were matched with practices in England, statin prescribing data and QOF achievement scores (for the first year post-QOF) were obtained. Crude prescribing data from matched practices were manipulated to provide a data set of Defined Daily Doses (DDDs)/1000 patients and cost/DDD/1000 patients for each statin drug entity covering 1 year before and after the introduction of QOF. QOF achievements were converted into percentage scores for matched practices. Main outcome measure: Cost per defined daily dose (DDD) per 1,000 patients  RESULTS: Significantly less statins (DDD/1,000 patients) were dispensed in Northern Ireland compared with the matched region in England both before and after the introduction of QOF (P <0.001). Significantly more statins, however, were dispensed in both regions after the introduction of QOF. As a result of the introduction of QOF, the cost/DDD/1000 patients rose by £13.17 in NI, but fell by £3.76 in the matched region in England. CONCLUSIONS: Strategies should be considered to educate prescribers on cost-effectiveness by increasing their awareness of the negative budgetary impact resulting from early adoption of new and expensive statins and by encouraging generic prescribing.