OBJECTIVE: Low-dose Aspirin is standard care in patients with a history of cardiovascular disease (CVD). In primary prevention the use of low-dose Aspirin is not yet fully established although meta-analyses and US and European guidelines support its use in persons at increased CVD risk. This study assessed the health-economic consequences of the use of low-dose Aspirin in the primary prevention of CVD in China. METHODS: Based on results (benefits and harms) reported in the meta-analyses of Hayden and Eidelman, a Markov model was developed to predict the cost-effectiveness of low-dose Aspirin in the primary prevention of CVD. The model consists of 5 health states: no history of CVD, history of stroke, history of myocardial infarction, history of CVD and death. A 10-year time horizon and 1-year cycles were used. Secondary prevention data were derived from the Aspirin group of the CAPRIE-study (1996). Direct costs (years 2000-2003) from the payer's perspective were used (sources: Chinese Ministry of health for acute and a Delphi-panel for follow-up costs). Effects were expressed in Life-Years (LY) and Quality-Adjusted-Life-Years (QALY). Utility data (TTO) were obtained from published data. Discounting was applied (3% on effects and costs). One-way and Probabilistic sensitivity analysis was applied. RESULTS: For subjects with a 10-year risk of coronary heart disease (CHD) of 15% the model results in a 10-year cost (±StErr) of 11,233±1,995Yuan (1,060±188€) without and 10,304±1,537Yuan (972±145€) with Aspirin. Low-dose Aspirin treatment saves on average 929±781Yuan (88±74€) per patient. LY were respectively 8.33±0.01 and 8.36±0.02, QALY 8.20±0.02 and 8.24±0.03. Monte Carlo analysis showed Aspirin-dominance in 87.1% of cases. Savings start in the fourth year. CONCLUSIONS: Administering low-dose Aspirin to individuals with a ten-year risk of CHD of 15% and more is life and cost-saving from the Chinese health care payer's perspective. Sensitivity analyses (CHD risk and bleedings) proved the results robustness.