OBJECTIVES: Although statins are the mainstay of cholesterol management in Scotland, there remains a group of patients who are ineligible for such treatment due to contraindication or intolerance.  This analysis estimates the cost-effectiveness of extended-release nicotinic acid/laropiprant 2 g/40 mg (ERN/LRPT), versus ezetimibe 10 mg, as monotherapy for the treatment of mixed dyslipidaemia in Scotland in patients not currently receiving statin therapy. METHODS: The analysis was based on a previously published Markov model.  Risk equations, based on the Framingham Heart Study, were used to model CHD-event rates in patients with established CHD, diabetes mellitus (DM) or a 10-year CHD-risk ≥20%.  The model was run on a cohort of 2976 patient profiles extracted from the General Practice Research Database.  All patients had abnormalities in low-density-lipoprotein cholesterol (LDL-C≥2.0 mmol/L), high-density-lipoprotein cholesterol (HDL-C<1.0 mmol/L [men], 1.2 mmol/L [women]) and triglycerides (TG>1.7 mmol/L).  ERN/LRPT efficacy data were taken from the results of a published clinical trial, and ezetimibe data taken from a meta-analysis of monotherapy trials.  Results were reported as the cost per quality-adjusted life year (QALY) gained. RESULTS: When compared to the use of ezetimibe, ERN/LRPT led to an increase in both QALYs and costs across the three patient-risk sub-groups.  In patients with CHD, the base case analysis estimated an incremental cost effectiveness ratio (ICER) of £7559.  Base case results in patients with DM and patients facing a 10-year CHD risk ≥20% were £9,361 and £11,980, respectively.  ICERS in the majority of sensitivity analyses did not vary by more than +/- £3000 from the base case. CONCLUSIONS: When compared to ezetimibe, ERN/LRPT is projected to be cost-effective for the management of lipids in patients for whom the addition of statin is inappropriate or not tolerated, as reflected in the guidance issued by the Scottish Medicines Consortium.