OBJECTIVES: Statins are antilipidemic agents which are widely used as standard therapy for primary and secondary prevention of cardiovascular diseases (CVD) and stroke caused due to elevated cholesterol levels and atherosclerosis. Atherosclerosis being a complex process can be efficiently treated by statins. The main objective of the current study is to assess the cost effectiveness of rosuvastatin and atorvastatin in primary and secondary prevention of CVD and stroke conditions. METHODS: A Cross sectional ambispective study was conducted in tertiary care hospitals in Warangal, Telangana, India. The 200 patients who were on statins therapy were interviewed and 120 patients were enrolled into the study based on inclusion and exclusion criteria of the study. Drug costs, number of events avoided and lipid profiles were recorded, cost effectiveness ratio was determined using basic ICER(incremental cost effectiveness ratio) formula. statistical analysis was done using SAS 9.2 version. RESULTS: PRIMARY PREVENTION GROUP (rosuvastatin 5mg, 10mg against atorvastatin 10mg, 20mg) revealed that patients receiving rosuvastatin showed less fluctuations than atorvastatin and maintained optimum lipid levels such as serum cholesterol of 179.97±31.32 mg/dl and 169.26±34.53mg/dl, High density lipoprotein (HDL) of 41.16±3.79mg/dl and 40.71±15.38mg/dl, triglycerides of 142.99±79.12mg/dl and 155.94±92.52mg/dl, low density lipoprotein of 115.38±29.5mg/dl and 100±29.74mg/dl for rosuvastatin and atorvastatin respectively. SECONDARY PREVENTION GROUP (Rosuvastatin 10mg, 20mg against atorvastatin 40mg, 80mg) revealed that rosuvastatin was most cost effective based on calculated cost effectiveness ratio. The drug cost of rosuvastatin to avoid an event was found to be Rs 513.90 when compared to Rs 803.37 for atorvastatin. CONCLUSIONS: : The above results reveal that rosuvastatin was more cost effective drug. Inspite of its high unit cost rosuvastatin showed reasonable effectiveness in avoiding the no.of events occuring when compared with atorvastatin, even with low unit cost due its less effectiveness leading to raise in total cost.