Objective: To evaluate and compare the relative medical costs associated with up-titration of statin therapy (Rosuvastatin, Atorvastatin, Simvastatin, Pravastatin) in order to reach Canadian Lipid Goals. Methods: Efficacy measures and Canadian LDL-C goal attainment rates on the studied statins were derived from a head to head RCT (McKenney JM et al. 2003). The need for up-titration was modeled during 3-month intervals for a period of one year based on the goal attainment rates for each statin and dose. The total number of physician visits and up-titration from the initial start dose to target lipid goals was captured and associated medical costs were calculated. Medical costs consisting of the physician visits and lab costs were derived from the Ontario Health Insurance (OHIP) Schedule of Benefits and Fees. Results: After initiation on 10mg for each statin, out of a cohort of 100 patients for each treatment arm, 15 patients required dose up-titration to target lipid goals with Rosuvastatin, 32 with Atorvastatin, 34 with Simvastatin, and 56 with Pravastatin. Additional up-titration to higher doses was further required for 1 patient on Rosuvastatin, 8 on Atorvastatin, 13 on Simvastatin and 20 patients on Pravastatin. Over one year, 16% of patients treated with Rosuvastatin need to be titrated compared with 40% on Atorvastatin, 47% on Simvastatin and 76% on Pravastatin. Total costs for general physician visits and up-titration was estimated to be $6516 for Rosuvastatin, $7849 for Atorvastatin, $8244 for Simvastatin, and $9834 for Pravastatin. Conclusion: Statins differ in efficacy at getting patients to target lipid goals. Differences in efficacy can translate for a need of dose titration, and potential increased costs in direct medical expense. This analysis shows that Rosuvastatin may offer increased savings in physician visits and lab costs since fewer patients need to be up-titrated to meet target lipid goals.