OBJECTIVES: To assess the cost-utility of Eprosartan (Teveten) compared to the two most commonly used ACE-inhibitors in Sweden. METHODS: Cost-effectiveness from the societal and health-care payer perspective was evaluated using Monte Carlo-simulation within a Markov framework. The risk of cardiovascular and cerebrovascular events was based on the Framingham study. Costs (2005 Swedish Kronor, SEK, 1 € = 9,22 SEK) and utilities were based on published sources. The treatments effect on systolic blood pressure (SBP) was taken from randomized clinical trials and the risk reduction due to lower SBP was based on metaanalysis. Treatment lasted for 5 years and patients were followed for the remainder of their life. 3% discounting of costs and effects was applied. RESULTS: From the health-care payer perspective, the cost-effectiveness compared to Enalapril ranged from 226 098 SEK/QALY for a 40 year-old non-diabetic cohort with 50% males (corresponding to a 5-year risk of 4.4%) to 35,253 SEK/QALY for 80-year olds with diabetes (corresponding to a 5-year risk of 41.7%). The corresponding figures compared to Ramipril was 143 857 SEK/QALY – 10 263 SEK/QALY. From a societal perspective (including cost in added years of life) the figures were 176 237 SEK/QALY – 283 882 SEK/QALY and 93 996 SEK/QALY – 258 891 SEK/QALY. CONCLUSION: The incremental cost-effectiveness ratios all fall below the commonly used threshold value of 500 000 SEK per QALY, even if costs in added years of life are included which gives higher ratios for treatments that extend life in older age groups. Eprosartan thus appears to be a cost-effective strategy compared to Enalapril or Ramipril.