None of the published models report good value (<$50000 per QALY added; Table 12), and virtually all indicate low value ( $150000 per QALY added). All models pro- jected mortality benefit by assuming that mortality rate reductions either parallel LDL-C loweringS7.1-4 or parallel RRRs for nonfatal ASCVD events. All models project higher lifetime cost from use of PCSK9 inhibitors because the cost will exceed any sav- ings from prevention of cardiovascular events. To be cost-effective by conventional standards, the cost of PCSK9 inhibitors will have to be reduced on the order of 70% to 85% in the United States.S7.1-3 At any given price, the economic value of PCSK9 inhibitors will be improved by restricting their use to patients at very high-risk of ASCVD events, as recommended in the present guidelines. The inverse relationship between improved survival and the incremental cost-effective- ness ratio (Figure 3) indicates that the economic val- ue of PCSK9 inhibitors will be improved by selecting higher-risk patients. One simulation model suggested that restricting the use of PCSK9 inhibitor therapy to patients with baseline LDL-C levels 119 mg/dL ( 3 mmol/L), instead of 70 mg/dL ( 1.8 mmol/L), would improve their cost-effectiveness to $150000 per QALY added, instead of $268000.S7.1-5 Another study pro- jected a similar improvement in economic value.S7.1-6 Thus, raising the threshold for LDL-C on maximal statin therapy to initiate a PCSK9 inhibitor should im- prove its cost-effectiveness (Figure 3). Only 2 economic models have specifically examined the value provided by PCSK9 inhibitors for primary pre- vention in patients with heterozygous FH (Online Data found low value when PCSK9 inhibitors were used for FH ($503000 per QALY added), whereas the second modelS7.1-8 reported inter- mediate value (incremental cost-effectiveness ratio of $75900 per QALY added). Consequently, the value of PCSK9 inhibitor therapy in FH is uncertain. 