The clinician should explain the patient s risk of clinical ASCVD and how the treatment recommendations reduce ASCVD risk. The patient should verbalize values, attitudes, abilities, concerns, and personal goals for making lifestyle changes and taking medications, including concerns about cost.S6-22 The clinician may use a checklist to facilitate shared decision-making with the patient (Table S8 in the Web Supplement). The clinician should use tools and techniques to support shared decision-making.S6-7,S6-22 S6-26 Decision aids may allow the patient to be more knowledgeable, have better risk perception, and have a clearer understanding of their values.S6-8,S6-27 Question prompt lists may increase knowledge by including questions about the purpose or goal of treatment, the risk with and without treatment, how the medication should be taken, potential side effects and how to manage them, when to notify the office, and monitoring and follow-up. Motivational and decision coaching may also promote patient knowledge and satisfaction. 7. COST AND VALUE CONSIDERATIONS 7.1. Economic Value Considerations: ACC/AHA clinical guidelines now recognize the im- portance of considering economic value in making recommendations, in accordance with the principles established by an expert group.S7.1-1 tors further reduce LDL-C when combined with other LDL-lowering drugs, and they reduced composite car- diovascular events in 2 RCTs of high-risk, secondary- prevention patients with clinical ASCVD.S7.1-2 The cost- effectiveness and economic value of PCSK9 inhibitors have been assessed by using simulation models (Online Data Supplements 47 and 48); the published models are based on different sets of assumptions. Compared with statin therapy for secondary prevention, PCSK9 inhibitors have incremental cost-effectiveness ratiosS7.1-3 from $141700 to $450000 per quality-adjusted life- year (QALY) added, at mid-2018 list prices. None of the published models report good value (<$50000 per QALY added; Table 12), and virtually all indicate low value ( $150000 per QALY added). 