OBJECTIVES: To investigate under which circumstances statins can be considered cost-effective in primary prevention of CHD, and to identify the most sensitive parameters. METHODS: A Markov Model is used to tackle the research question for the health insurance and the social insurance in Germany. Life years gained are chosen as effectiveness parameter. Mortality is based on the concept of Gompertzian analysis, linking mortality rates for persons with and without coronary heart disease (CHD). Costs components comprise of prevention costs, costs in the life years gained, national insurance contributions and avoided costs for CHD-treatment. Age and gender specific costs and expenditures for health states are estimated from data of the social insurance including pension payments. CHD-risk estimates are primarily based on Framingham risk equations, but an alternative method using current CHD-mortality data is used as well. RESULTS: With yearly Statin prices of 300 € (€/$=.9) and a relative CHD-risk reduction of 28%, statin treatment für a 50 year old male with a yearly CHD-risk of 1,5% would cost between 23,000 € and 26,000 € per life year gained for the social insurance and 13,000 € and 16,000 € for the health insurance. For higher CHD-risks statin treatment gets more cost-effective. At a given value of CHD-risk, cost-effectiveness is generally better for younger patients. The most sensitive parameters are the yearly statin prices und the relative risk reduction. Per rise in statin prices of 100 €, cost-effectiveness would increase between 5,000 € and 7,000 € per life year gained depending on age and gender. Avoided CHD-treatment costs, however, have only a minor impact on the cost-effectiveness-ratio. CONCLUSIONS: Treatment guidelines for CHD prevention incorporating cost-effectiveness considerations are vulnerable to future statin pricing after the soon fall of protection by patent. Correct risk estimation remains one important objective in targeting recources for primary CHD-prevention.