OBJECTIVES: To evaluate the cost-effectiveness of atorvastatin, rosuvastatin, and simvastatin in reducing LDL-cholesterol (LDL-C) and in treatment of patients with high risk of fatal cardiovascular disease to meet the European LDL-C target level of 2.5 mmol/l. METHODS: The efficacy of statins in terms of mean percent reduction in LDL-C was determined by literature review and Bayesian random effects meta-analysis. A simulation model was created to evaluate the proportion of patients treated to the LDL-C target (PTT) level of 2.5 mmol/l. The uncertainty related to the independent variables was modeled with Bayesian MCMC-simulation with the use of WinBUGS software. The measures of cost-effectiveness were calculated by annual medicine costs per PTT and by incremental cost-effectiveness ratios (ICERs). The annual medicine costs were applied from Finnish medicine tariff. RESULTS: All the patients with baseline LDL-C level of 4,0mmol/l (SD=0,25mmol/l) reached PTT when using rosuvastatin 10mg, 20mg or 40mg. Corresponding numbers for simvastatin 20mg, 40mg and 80mg were 4%, 57%, and 99%, respectively. The incremental annual cost of rosuvastatin 10mg compared to generic simvastatin 40 mg was 710 € per additional PTT. When patient's baseline LDL-C level exceeded 4.2 mmol/l rosuvastatin produced the lowest annual medicine costs per PTT. With lower levels of LDL-C simvastatin was the most cost-effective to use. Atorvastatin was less effective and more costly than rosuvastatin with all baseline LDL-levels and was therefore dominated. CONCLUSION: The cost-effectiveness of statins depends on patient's cardiovascular risk profile and baseline cholesterol level. In Finland rosuvastatin is cost-effective in reaching European LDL-C target of 2.5 mmol/l when patient's LDL-C level exceeds 4.2 mmol/l.