OBJECTIVES: The IMPROVE-IT study has shown that ezetimibe (EZ)  added to statin therapy provides additional benefit with respect to CVD outcomes. The objective of this study is to assess the economic value of EZ in CVD patients in the US healthcare system accounting for the change in price due to patent expiry. METHODS: We developed a model to project the long term cost and benefits of EZ added to statin therapy in patients with CVD and LDL-C values >=70 mg/dl. Risk reduction in CVD events were based upon the relationship between LDL changes and reduction in CV risk from CTT meta-analysis.   Cost and utility values were taken from recent assessments of statins in the US and Non-CVD death rates were based on US mortality statistics. An cohort of statin patients was identified from the IMS Pharmetrics and EMR databases. We conducted an evaluation where the price of EZ was fixed at the wholesale acquisition cost (WAC)  for the first year and the price of EZ was reduced by 90% after one year of therapy. RESULTS: We identified 548 patients in the IMS database between the ages of 35-75 with a history of CVD and LDL-C >=70 mg/dl. Patients were of 58 years age, with baseline LDL-C of 94.6 mg/dl, 55.5% were male and 35.6%  of had diabetes. The reduction in current WAC price of 90% after 1 year  resulted in an additional $1,363 in cost and a gain of 0.17 in QALYs,  for an additional $8,150/QALY gained. Reduction in event costs due to the addition of EZ offset 80% of the incremental total drug cost of statin plus EZ.  CONCLUSIONS: With the results of IMPROVE-IT and impending patent expiry, these results suggest that initiating  therapy with EZ is a clinical and cost-effective option for CVD patients treated with statins.