OBJECTIVE: A recently published analysis on the use of Cholesterol-Synthesis-Enzyme-Antagonists (CSEA) in Germany stated that with the investment of nearly €1 billion; 87% of all possible €2.8 million. patients can be treated sufficiently (Klose and Schwabe 2003). The aim of the presented study is to show the cost-efficacy as experienced by office based physicians of the CSEA treatment. METHODS: A cost-efficacy-analysis was conducted on base of the following data: Eight local experts (general practitioners, cardiologists) out of a rural as well as an urban setting assessed in a Delphi-Panel their practical experience of reaching a defined LDL-Cholesterol (LDL-C) target according to European treatment guidelines treating a patient with a predefined risk with CSEA. Total sales of CSEA in 2002 as stated by IMS (Institute for Medical Statistics) and actual drug prices (Rote Liste, 2003) were used to calculate total costs of CSA treatment in Germany from the German payers perspective for the year 2003. (Discounts from the whole saler, pharmaceutical industry, retail pharmacies and patients copayments were taken into consideration). RESULTS: Total efficacy as stated by the physicians depends on CSEA and was seen between 53% and 76%. The total efficacy experienced by the physicians weighted with 2002 sales was 71%. Total sales in 2003 are €995.6 million. In total €1.4 billion must be invested for completely (100%) reaching the LDL-C goal of the European treatment guideline. CONCLUSION: Although it is stated by Klose and Schwabe (2003) that nearly €2.million of estimated €2.8 million patients could be treated sufficiently with CSEA the results of our study indicate that the investment for a sufficient treatment must be higher or the treatment itself must be improved by more efficient drugs.