OBJECTIVES: The Losartan Intervention For Endpoint Reduction (LIFE) in hypertension study was a randomised, double-blinded trial comparing effects of losartan with atenolol on cardiovascular morbidity and death. A population of 9193 hypertensive patients with left ventricular hypertrophy (LVH) in different countries was studied. As compared to atenolol, losartan reduced the combined risk of cardiovascular morbidity and mortality by 13% (p=0.021), and reduced risk of stroke by 25% (p=0.001), despite comparable blood pressure control. Our objective was to conduct a cost-effectiveness analysis of losartan compared with atenolol from the Dutch health care perspective. METHODS: Utilisation of losartan and atenolol within the trial period and an estimation of direct medical costs of stroke for the Netherlands were combined with estimates of reduction in life expectancy through stroke. Medication cost and stroke incidence during 5.5 years of patient follow-up were estimated separately, adjusted for the baseline degree of LVH and Framingham risk score. To estimate lifetime stroke costs, the cumulative incidence of stroke was multiplied by the lifetime direct medical costs attributable to stroke. All costs in 2004 Dutch prices were discounted at 4%, and effects at 1.5% (new guideline). RESULTS: Prevention of stroke resulted in a gain of 5.1 discounted life years. As a consequence, losartan treatment resulted in 0.081 life years gained per patient. Losartan reduced stroke related cost by €946. After inclusion of study medication cost, net cost per patient was €237 higher for losartan than atenolol. The net cost per life year gained was €2926 which is below the Dutch pharmacoeconomic threshold of €20,000/LYG for accepting interventions. The corresponding probability of a cost-effectiveness ratio below the Dutch threshold was 0.96. CONCLUSIONS: In the Netherlands, treatment with losartan compared with atenolol is a cost-effective intervention based on the reduced risk of stroke observed in the LIFE trial.