目的：本研究之目的在發展方法學，以statins為例，從六個具有治療相等性的statins中，選擇較符合成本效益的statin(s)以取代其他statins。

方法：運用成本效果分析的方法學，比較六個statins之醫療總成本及療效結果，以選出較符合成本效益的statin(s)。成本之計算乃利用健保資料庫分析，取得混合型血脂異常及原發性高膽固醇血症病人以statin單獨治療六個月之門診相關醫療花費，包括藥費、診察費、檢驗費及藥事服務費。療效結果則是參考已發表的statins類藥品之完整系統性回顧報告書，進行本研究所需之相關數據的萃取及整合。取得本研究目標族群使用各statin長達六個月之門診總成本及相對應的療效後，再以Karlsson等人發表的決策分析流程進行六個statin之成本效果分析比較。

結果：成本分析的結果顯示，每人六個月門診平均總成本最低的是rosuvastatin（NT$6,850），最高的則是pravastatin（NT$9,078）。在療效數據方面，從納入的60篇文獻整合結果發現，於「降低LDL-C平均濃度百分比」這個療效指標上，效果最好的是rosuvastatin，最差的是fluvastatin。由成本效果分析之結果發現：與其他五個statins比較，rosuvastatin乃是效果最好且門診總成本最低（最佔優勢）的statin。Rosuvastatin相較於沒有治療，每讓一名病人多降低1% LDL-C平均濃度約需花費新台幣153元。

結論：本研究建立了一套利用成本效果分析評估同類藥品中，何者最符合成本效益以執行治療取代的方法學，進而選出最佔優勢（dominant）的statin為rosuvastatin；同時也期盼醫院藥事委員會將藥物經濟學分析的方法應用到藥品處方集管理的決策過程中，如此除了能讓藥品的使用相關成本降至最低之外，也能藉此讓病人群獲得最大的整體效益。

Purpose: To develop methodologies for selecting the most cost-effective statin among the statins which are therapeutically equivalent to use in the hospital setting.
Methods: The study used the cost-effectiveness analysis to compare the health care costs and effectiveness of the six statins and select the most cost-effective statin among the six statins. Direct medical costs were derived from BNHI claimed-database, including the cost of drugs, physician services, dispensing services and laboratory tests of the patients with mixed dyslipidemia or primary hypercholesterolemia. The time horizon is six months which starts from the first date of dispensing that single specific statin for the naïve patients. The effectiveness was derived from the systematic review of statins literature which was published by Oregon Health and Science University. Subsequently, the decision rule algorithm of cost-effectiveness analysis established by Karlsson and Johanesson was adopted to determine the best choice of statin(s).
Results: With respect to the cost, rosuvastatin had the lowest treatment cost of six months ambulatory care per patient (NT$6,850), whereas pravastatin had the highest (NT$9,078). Concerning the effectiveness, rosuvastatin was associated with the greatest effectiveness in terms of the reduction of LDL-C, whereas fluvastatin had the lowest effectiveness. In the base-case and sensitivity analysis, rosuvastatin dominate the other five statins. Compare to do-nothing, the incremental cost per additional 1% reduction in LDL-C was NT$153 for rosuvastatin.
Conclusion: The study has developed a method for selecting the most cost-effective drug among drugs which are therapeutically equivalent, and the result indicated rosuvastatin was the dominant option among the six statins. Meanwhile, we hope pharmacoeconomic information could be used in formulary decision-making process by P&T committee in the hospital setting, not only for minimizing the total health care cost but also for maximizing the aggregate effectiveness