OBJECTIVES: To estimate the incremental cost-effectiveness ratios (ICER) of statin monotherapy for attaining NCEP ATP II LDL-cholesterol (LDL-C) goal levels from a managed care organization (MCO) perspective. METHODS: Total and dyslipidemia attributable costs of care (medication, physician office visits, laboratory) and consequences (resource use associated with atherosclerotic vascular events) were captured between 1/98 and 12/00 for patients newly started on statin therapy from a southeast US MCO. Costs (year 2000 $US) were converted using an inflation adjusted discount rate. Follow-up costs and probabilities of attaining LDL-C goal were estimated using multivariable OLS and logistic regression, respectively. Costs were log transformed prior to regression. Covariates were selected based on fit and clinical relevance, and included baseline total costs, age, gender, cogent clinical subgroups, and duration of follow-up. Mean differences in all pair-wise ICER were evaluated by applying non-parametric bootstrap techniques. RESULTS: A total of 1,651 patients were captured and followed for a median duration of 19.4 months. Fluvastatin, pravastatin, atorvastatin, and simvastatin adjusted mean attributable costs and respective adjusted probabilities of obtaining goal were $1,354 (0.51), $2,320 (0.57), $2,451 (0.75), $2,964 (0.7), respectively. In the base case analysis, the mean [95%CI] attributable cost per LDL-C goal obtained vs. no therapy was: fluvastatin: $2,654 [$828-$4,878], atorvastatin: $3,268 [$1,009-$5,994], pravastatin: $4,070 [$1,269-$7,800], simvastatin: $4,234 [$1,327-$7,818]. The ICER to obtain one additional goal for atorvastatin, simvastatin, and pravastatin as compared to fluvastatin was $4,570 [$1,349-$9,664], $8,473 [$2,537-$19,558], $16,100 [$3,537-NW], respectively. The ICER of atorvastatin dominated simvastatin (simvastatin higher mean [95%CI] cost and lower mean [95%CI] probability of obtaining goal). The results were not sensitive to changes in inflation rate or model selection. CONCLUSIONS: This analysis suggests atorvastatin has a reasonable incremental cost per goal attained as compared to fluvastatin, pravastatin, and simvastatin in this population. Atorvastatin, compared to simvastatin, provided more effect for less cost.