OBJECTIVES: The purpose of this study was to evaluate the relative cost-effectiveness (cost-utility) of the angiotensin II antagonist eprosartan versus other antihypertensives (nitrendipine, perindopril, enalapril) in a secondary prevention setting (hypertensives with cerebrovascular disease at baseline) in Belgium, Germany, Spain, UK and Sweden. METHODS: The HEALTH model (Health Economic Assessment of Life with Teveten® for Hypertension) is an object-oriented probabilistic Monte Carlo simulation model. It combines a Framingham-based risk calculation with a systolic blood pressure approach to estimate the relative risk reduction of cardiovascular and cerebrovascular events based on recent meta-analyses. For eprosartan an additional risk reduction was modelled according to the results of the MOSES study (‘Morbidity and Mortality after Stroke - Eprosartan Compared to Nitrendipine for Secondary Prevention'). Costs and utilities were derived from published estimates considering country-specific healthcare payer perspectives. Drug prices of the comparators were based on the cheapest generics. The treatment time horizon simulated was 2.5 years (mean observation period of the MOSES study) modelling follow-up effects over lifetime. Costs and effects were discounted according to country-specific guidelines. RESULTS: During a 2.5-year treatment time horizon modelling follow-up effects over lifetime in 1,000 patients eprosartan treatment avoided about 58 events (26 cardiovascular, 32 cerebrovascular) and produced about 30 incremental QALYs versus the compared treatments. Irrespective of country and comparator the cost per QALY gained by eprosartan never exceeded €20,000 and therefore went far below the estimated willingness-to-pay threshold of €30,000. The probabilistic sensitivity analyses fortify these outcomes by showing a probability of 90-100% that eprosartan is a cost-effective treatment strategy. CONCLUSION: Even comparing eprosartan to low-priced generic substances, the HEALTH model simulations provide evidence that eprosartan treatment is associated with obvious health benefits being obtained at reasonable cost. Eprosartan should therefore be considered a good treatment option for hypertensive patients with cerebrovascular disease.