OBJECTIVES: The PROVE IT-TIMI 22 trial demonstrated clinical benefit of intensive lipid lowering (atorvastatin 80mg) vs. moderate lipid lowering (pravastatin 40mg) in patients with acute coronary syndrome (ACS). Prior US analysis found lower net costs for intensive Rx. The objective of this analysis was to evaluate cost-effectiveness of intensive vs. moderate statin therapy in ACS patients in the UK, Germany and Canada where generic pravastatin is available and hospitalization costs lower than in the US. METHODS: Hospitalization and length of treatment were obtained from PROVE-IT case report forms. Hospitalizations were classified by relevant DRG system and multiplied by associated hospitalization costs in the UK, Germany and Canada. Drug costs were obtained from each country's public or tariff prices. RESULTS: Compared with moderate pravastatin therapy, intensive atorvastatin therapy was associated with fewer hospitalizations (1,301 vs. 1,444; 0.62/pt vs. 0.70/pt). Total costs (hospital+drug) per patient of intensive vs. moderate therapy were £3,184 vs. £3,236 (UK), €5,242 vs. €5,515 (Germany) and CA$7,386 vs. CA$8,087 (Canada), with savings per patient of £56, €284 and CA$701 respectively over the 2-year study period. Thus, increased drug acquisition costs were more than offset by reduced hospitalization costs in all three countries. Sensitivity analysis on treatment pattern variations, events and costs will be conducted. If the PROVE-IT results are generalizable to all ACS patients, the savings from intensive vs. moderate statin therapy per two years of treatment would be ₤5.6 million, €28.4 million and CA$70.1 million for every 100,000 ACS patients in the UK, Germany and Canada, respectively. CONCLUSIONS: As observed in PROVE-IT, intensive atorvastatin therapy reduced clinical events and costs compared to moderate pravastatin therapy among ACS patients in the UK, Germany and Canada and thus is clinically beneficial at a lower overall cost among PROVE-IT ACS patients, allowing allocation of resources to other therapy options.