OBJECTIVES: CVD prevention treatment guidelines recommend lowering cholesterol to target levels appropriate for patients with existing CVD and/or diabetes.  Clinical trial data on the fixed-dose combination of ezetimibe and simvastatin (VYTORIN™) show it provided greater LDL-C reduction than atorvastatin and got more patients to ATP III LDL-C goal of <100mg/dL.  The objective of this study was to assess the cost-effectiveness of 1st line treatment with VYTORIN compared to atorvastatin in CHD and/or diabetic patients in a Korean population. METHODS:  A previously validated decision analytic model (Cook et al., 2004) with discrete health states is used. Movement among health states depends on risk of CHD events based on Framingham Heart Study risk equations and non-CHD related mortality rates in Korea.   Country-specific risk profiles from a cohort of the Korean patients (N=275, mean baseline LDL-C 163.4 mg/dL, age 57.6, smoker 77.8%, diabetic 61.1%) were used as baseline starting point for treatment.  Disease progression is altered through LDL-c reductions as observed in clinical trials (Ballantyne et al., 2005; Feldman et al., 2004; Stein et al., 2004). Medication, laboratory, and CHD event cost were from publicly available sources in Korea.  The incremental cost per quality-adjusted-life-year saved (KRW/QALY) is estimated for a lipid modification regiman starting with VYTORIN 10/10mg compared to initiating with atorvastatin 10mg.  RESULTS: The weighted mean goal attainment rate at the end of one year was 86.6% for patients treated with VYTORIN compared to 68.3% for patients treated with atorvastatin.  The difference in goal attainment between treatment groups was greatest for patients with CHD and/or diabetes.  The incremental cost per QALY for VYTORIN was KRW 16,954,960.  This is approximately 1X per capita GDP in Korea. CONCLUSIONS: The results suggest that initiating 1st line lipid management with VYTORIN in Korea is cost-effective relative to atorvastatin.