Hyperlipidemia is a lipid metabolism disorder characterized by elevated blood lipid levels and is a major risk factor for cardiovascular disease. The selection of antihyperlipidemic therapy should consider not only clinical effectiveness but also economic efficiency. This study aimed to compare the cost-effectiveness of atorvastatin and fenofibrate in outpatients with hyperlipidemia at a regional general hospital in Central Java. This study employed a nonexperimental, quantitative descriptive design with retrospective data collection from medical records and administrative data. The study sample consisted of adult outpatients diagnosed with hyperlipidemia who received atorvastatin or fenofibrate monotherapy for at least three months and met the inclusion criteria. Therapeutic effectiveness was assessed based on the achievement of lipid treatment targets, while the cost analysis was based on direct medication costs. The results showed that atorvastatin had greater therapeutic effectiveness than fenofibrate, with 43% of patients achieving treatment targets compared with 27% in the fenofibrate group. The average medication cost per patient was IDR 45,000 for atorvastatin and IDR 60,000 for fenofibrate. The cost per patient achieving the treatment target was lower in the atorvastatin group (IDR 104,651) than in the fenofibrate group (IDR 222,222). In conclusion, atorvastatin was more cost-effective than fenofibrate for the management of hyperlipidemia among outpatients.