Abstract Background After market introduction of atorvastatin in Germany, the Institute for quality and efficiency in health care (IQWiG) concluded that atorvastatin, as compared to other less potent statins, was not associated with added value and levelled reimbursement to that of other statins. This decision being highly controversial, we hypothesized that a cost-effectiveness analysis based on real-world outcome data may have proven cost-effectiveness of atorvastatin, favouring corresponding reimbursement. Methods We investigated the introduction of highly potent statins in a cohort of 10,875 patients undergoing percutaneous coronary intervention (PCI) in a high-volume single centre in Germany between 2010 and 2017 and whether this conferred a clinical benefit as compared to statins with low potency. Routine clinical follow-up was performed at 30 days, 1 and 3 years after intervention with assessment of death, repeat revascularisations and myocardial infarction. Cox proportional hazards regression analyses were performed to adjust for differences in baseline patient characteristics. Based on the outcome data, a cost-effectiveness analysis of atorvastatin was performed, complemented by scenario analyses. Results Clinical benefit was present for high potency statins but was limited to all-cause death and not present in rates of myocardial infarction or revascularisations. Regarding cost-effectivenesss, an incremental cost-effectiveness ratio (ICER) of €6,311 / quality-adjusted life year (QUALY) was obtained for atorvastatin in the base case with life time horizon. In scenario analyses, the highest ICERs was €12,216 / QUALY (Figure 1). Conclusions We demonstrate that cost-effectiveness analysis can be performed based on routine treatment data. Hence, when there is uncertainty regarding cost-effectiveness analyses based on data from RCTs, timely restricted reimbursement could be a novel way of accumulating such treatment data and serve for evaluation of cost-effectiveness in real-world treatment conditions. Figure 1 Funding Acknowledgement Type of funding source: None