OBJECTIVES: To estimate the cost per patient successfully treated to NCEP ATP-III goal with high-potency statins or statin/combinations. METHODS: We constructed a decision analytic model (from the payer perspective) comparing four statins or statin combinations: atorvastatin (40-80mg), rosuvastatin (10-40mg), simvastatin/ezetimibe (Vytorin;10/10-10/40mg), and simvastatin 80mg. Costs were based on best available Military Health System (MHS) prices, and only included drug acquisition costs. Monte Carlo methods were used to generate a distribution of starting LDL values for a hypothetical cohort of 1000 patients. The mean starting LDL was 189.1 (SD=18.6), with individual patient LDLs normally distributed. The percentage of patients in each NCEP ATP-III risk group was: low risk 41% (LDL goal <160 mg/dl), moderate risk 30% (LDL goal <130 mg/dl), high risk 29% (LDL goal <100 mg/dl). Distributions of efficacy values (% LDL reduction) based on clinical literature were generated for each treatment arm. The primary outcome was the percentage of patients successfully treated to individual NCEP ATP-III goals based on starting LDL and risk group. The time horizon was one year, without discounting. Sensitivity analysis was performed to account for uncertainty. RESULTS: Vytorin was found to be most effective with 90% of patients successfully treated to goal compared to 78.2%, 82.1%, and 82.2% for simvastatin, atorvastatin, and rosuvastatin, respectively. Vytorin was the preferred strategy, dominating other treatments at a cost of $431 annually per patient successfully treated to goal. CONCLUSION: Using literature-derived estimates for % LDL lowering efficacy, we compared high-potency antilipidemics based on the percentage of patients successfully treated to goal. Estimates were similar to outcomes reported in clinical trials. At DoD drug acquisition costs, Vytorin appeared to be the most cost effective.