OBJECTIVES: Statin therapy reduces the rate of cardiovascular disease, but high costs in combination with a large population eligible for treatment ask for priority setting. Although trials agree on the size of the benefit, economical analyses of statins report contradictory results. METHODS: We reviewed cost effectiveness analyses comparing statins with no treatment and sought to synthesize cost effectiveness ratios for categories of risk of coronary heart disease and age. Data Sources: Medline, the British National Health Service Economic Evaluation database and authors' reference lists. We searched for studies comparing statins to no treatment for the prevention of cardiovascular disease in adult male populations. Reviews and meta-analyses were excluded. Studies needed to present cost per Years of Life Gained/Saved (YLS, YLG) as outcome. Studies comparing statins with other statins, or other medicaments were excluded. RESULTS: Twenty-four studies were included, yielding 216 cost effectiveness ratios. As expected, cost effectiveness ratios increase with decreasing absolute risk. However after stratification by absolute risk, heterogeneity of CER is large with outcomes varying from savings to US$ 59,000 per life year saved in the highest risk category and from US$6500 to 490,000 in the lowest risk category Disagreement increased at lower levels of risk. Absolute risk was the only significant predictor of cost effectiveness ratios. Various significant interactions with absolute risk were found. CONCLUSION: Statin therapy is cheap for high levels of risk, but discrepancies exist at lower levels of risk. Although the cost-effectiveness of statins depends mainly on absolute risk, factors like age, funding source and methodological variables might be behind the ample remaining heterogeneity of the CER after adjusting for absolute risk. Economic analyses need to increase their transparency to reduce their vulnerability to bias and increase their reproducibility.