The PROGRESS trial demonstrated the effectiveness of perindopril/indapamide in secondary stroke prevention (SSP). No existing economic study has incorporated these findings in a cost-benefit analysis. OBJECTIVES: The objective of this analysis was to evaluate the cost/benefit of perindopril/indapamide in SSP. METHODS: The model used a decision tree approach to estimate direct cost savings associated with SSP for a hypothetical cohort of 10,000 first stroke survivors from an HMO's perspective (1 Mio covered lives) over a 3-year time period. Incidence estimates for 2nd stroke and healthcare utilization as well as pharmacoeconomic estimates are presented for each year and separated for the two major stroke types (ischaemic and hemorrhagic stroke). First, stroke incidence and transition probabilities for healthcare utilization were abstracted from the published epidemiologic literature, incidence of second strokes from the PROGRESS trial. Cost for stroke-related hospitalization and re-hospitalization, rehabilitation, nursing home, and ambulatory care derived from national data and published literature. Historical cost data was inflation-adjusted to 2001 values, savings in the 2nd and 3rd year were discounted at 3%, and health care CPI inflation-adjusted at 4.7%. Treatment and control group (no SSP medication) were replenished after the 1st and 2nd year in equal numbers with newly SSP eligible patients (new first stroke survivors of the HMO population). Drug prices were defined as WAC-20% plus $5 co-pay. Sensitivity analysis on stroke incidences, selected transition probabilities and costs will be presented. RESULTS: SSP with perindopril/indapamide saved 28 lives and 110 strokes in the first year (after 3 years 169 and 325 respectively). Treatment achieved a net benefit of $803,000 in the first, $3,267,253 in the second and $6,207,814 by the third year. The cost per stroke prevented was $24,648 and $47,412 per death averted over the three year period. CONCLUSIONS: SSP with perindopril/indapamid saves lives and healthcare costs.