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To determine the cost-effectiveness of simvastatin in the secondary prevention of coronary artery disease (CAD) in Canada.Cost-effectiveness model based on results from the Scandinavian Simvastatin Survival Study (4S study) and cost and resource utilization data from Canadian sources to simulate the economic impact of long-term simvastatin treatment (15 years).Subjects with mean age of 59.4 years at recruitment into 4S study.Overall death rate and incidence of 5 major nonfatal events associated with CAD: myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, stroke and transient ischemic attack. Direct medical costs associated with CAD were assessed from the perspective of provincial ministries of health (i.e., costs borne by the ministries); the impact of simvastatin treatment on these costs was determined.The 4S study, with a median follow-up of 5.4 years, showed significantly reduced mortality and morbidity among the patients given simvastatin compared with the control subjects. Three premises were designed to predict the consequences of simvastatin treatment of CAD in Canada over 15 years, 10 years beyond the end of the 4S study. The 2 most probable premises, which assumed that the clinical benefits of simvastatin would be cumulative for either the first 10 years or the full 15 years of the model, had incremental costs per year of life gained (cost-effectiveness ratio) of $9867 and $6108 respectively.This model suggests that simvastatin provides a cost-effective approach to the long-term prevention of secondary CAD in Canada.