OBJECTIVES: Although the primary endpoint in the IDEAL study did not fully reach significance, the study showed that treatment with 80 mg atorvastatin daily led to a significant reduction in non-fatal myocardial infarction (MI) and revascularizations compared to 20-40 mg simvastatin. A separate analysis of patients with acute coronary syndromes showed a relative reduction of the risk of MI of 46%. Here we investigate the economic impact of this in Sweden. METHODS: A Markov model was constructed deriving transition probabilities from the intention-to-treat patient-level data in IDEAL. The model incorporated states for MI and revascularizations. Patients are treated for the duration of the trial (5 years), and followed for the remainder of their lives. Resource consumption associated with events was estimated based on the trial data. Analyses were conducted from a societal perspective with costs expressed in year 2007 €. Effectiveness was measured as quality adjusted life years (QALY) gained. Costs and effects were discounted at 3% per annum. Uncertainty was assessed through one-way sensitivity analysis and 2nd order Monte Carlo analysis where all parameter inputs were drawn from their underlying distributions. RESULTS: The predicted quality-adjusted survival of 10.65 years in the atorvastatin arm compared to 10.52 years in the simvastatin arm, an increase of 0.13 QALYs. Total life-time costs in the atorvastatin arm were 9387€ compared to 8888€, a difference of 499€. The cost to gain one QALY was 2361€. The results were robust to variation in model input parameters. CONCLUSION: Compared to the benchmarks used by the Swedish National Board of Health and Welfare in their prioritization guidelines in cardiovascular care, high dose atorvastatin would be cost-effective in the studied indication. As the present analysis represents a subgroup analysis of the IDEAL study the results should be interpreted with caution.