Secondary coronary prevention with lipid lowering drugs has become a major issue in health policy formulation due to the large upfront investment in drug therapy. The recently completed LIPID trial with pravastatin in secondary prevention immediately raise the question whether pravastatin might be cost-effective in Germany. We conducted a cost-effectiveness analysis from the perspective of third party payers. The following costs were included in the analysis: daily treatment costs of pravastatin, non-fatal myocardial infarction, coronary bypass operations and stroke. Life years gained were obtained by applying the declining exponential approximation of life expectancy. All calculations were standardized to 1,000 treated patients. The net costs of treating 1,000 patients (i.e. drug costs minus the costs of sequelae and interventions) are DM 8.4 Mio. In addition, a total of 405 life years may be saved through treatment. The corresponding cost-effectiveness of pravastatin treatment is DM 20,674,-(DM 17,314,-, discounted by 3% p.a.).