Previous guidelines made Figure 3. Cost-effectiveness analysis for PCSK9 inhibitors. Conceptual relationship between the clinical effectiveness of PCSK9 inhibitor therapy, measured in QALYs added compared with statin therapy, on the horizontal axis, and their clinical value, measured in dollars per QALY added, on the vertical axis. The top curve indicates the relationship at full U.S list price of PCSK9 inhibi- tor therapy ($14000/y), the middle curve indicates the relationship if the price were reduced by 50% (ie, to $7000/y), and the bottom curve indicates the relation- ship if the price were reduced by 75% (ie, to $3500/y). Reproduced from Hlatky et al.S7.1-3 CV indicates cardiovascular; and QALY, quality-adjusted life-years. CLINICAL STATEMENTS AND GUIDELINES use of risk-assessment algorithms (eg, Framingham risk scoring or PCE) to estimate risk. Although these equa- tions are useful, they may overestimate or underesti- mate risk for individual patients. For this reason, the introduced the clinician patient risk discussion to facilitate clinical decisions about appropriate therapy. In the present guidelines, the clinician patient risk discussion has been amplified and made an integral part of the clinical decision. In addition, in cases in which uncertainty exists, the mea- surement of CAC has been proposed as a third step in making a treatment decision. Each of these steps could be improved for future guidelines. 8.2.1. Continuing Refinement of PCE Because the population baseline risk may be continually declining in the US population, ongoing epidemiological study is needed to assess and update population risk. An example is the development of QRISK in the U.K. popula- tion, which is continually expanding its scope. 8.2.2. Improvement in Lifetime Risk Estimate The present guidelines include a lifetime ASCVD risk al- gorithm for those 20 to 59 years of age, but it is based on an insufficient database. 