OBJECTIVES: The purpose of this research is to estimate atorvastatin, simvastatin and pravastatin incremental cost-utility ratios in Mexican patients with hypercholesterolemia in secondary prevention and ages between 45-70 years. METHODS: A Markov model was used with five final outcomes: angina pectoris (AP), myocardial infarction (MI), cerebrovascular disease (CVD), absence of cardiovascular events and death. The follow up period was five years, applying a 5% cost-utility discount rate. The perspective was that of the National Health System (only direct medical costs). The utility measure was obtained by applying a survey to Mexican cardiologists with clinical experience and with the aid of survival tables published in the literature. The quality-adjusted life-years (QALYs) were constructed for each final outcome. Cost per event was obtained by reviewing patient clinical records and expert opinion. The sensitivity analysis was univariate and probabilistic and acceptability curves were constructed. RESULTS: Annual average medical care costs per event were: US$9,906 for AP, US$8,510 for MI, US$4,720 for CVD, US$2,093 in the absence of cardiovascular events, and US$13,744 in the case of death. The quality-adjusted life years for MI were 1.2 years, for AP 2.9 years, for CVD 1.0 years, in the absence of cardiovascular events 4.4 years, and in case of death 0.0 years. For atorvastatin, the expected cost for treatment during the follow up period was US$10,713, for simvastatin US$15,873 and for pravastatin US$14,193. Finally, QALYs for atorvastatin, simvastatin and pravastatin during that same period were 3.8; 3.5 and 3.7 years, respectively. CONCLUSIONS: Atorvastatin turned out to be dominant in Mexico and offered the treatment with more cost-utility for patients with hypercholesterolemia in secondary prevention, followed by pravastatin and simvastatin. Stochastic sensitivity analysis showed the same results.