OBJECTIVES: To assess the use and cost of antilipemic drugs in NHG institutions. METHODS: Dispensing data for antilipemic drugs for various NHG institutions from Jan-Sept 2003 was extracted and analysed using WHO ATC/DDD methodology (version 2004). Setting: Primary care: NHG Polyclinics (NHGP). Secondary care: Alexandra Hospital (AH) and Tan Tock Seng Hospital (TTSH) - the latter has large general medicine and geriatric departments. Tertiary care: National University Hospital (NUH) - which has a large cardiac department and an active lipid clinic. RESULTS: Statins accounted for 90% (88-92%) whereas fibrates accounted for 10% (8-12%) of total DDDs. Lovastatin and simvastatin predominated the antilipemic drugs use (83% of total DDDs). Although atorvastatin and pravastatin's usage was less than 7% of total DDDs, they accounted for almost 50% of the total cost for antilipemic drugs. The total usage and cost of antilipemic drugs were highest in NHGP. Atorvastatin and pravastatin were used more commonly in NUH and TTSH (22% & 17% respectively) and resulted in higher (2-3 times) average daily cost as compared to AH & NHGP (2% for both institutions). The analysis also revealed that NUH & NHGP have a higher average daily cost of bile acid sequestrants and nicotinic acid derivatives respectively due to the use of more expensive agents in these groups of drugs. CONCLUSIONS: Generally, the utilisation profile of the broad classes of antilipemic drugs was similar across the four institutions. Statins were the leading antilipemic drugs followed by fibrates. Some institutions used more expensive antilipemic drugs as compared to the others. This has significant cost implication to patients and institutions. A closer analysis of patterns of antilipemic drug usage would be needed to identify the reasons and desired outcomes for the use of these agents. This would also potentially derive initiatives that might help rationalise the prescription of these agents.