As described in the 2011 AHA policy statement, Value of Primordial and Primary Prevention Assessing the value of prevention in appar- ently healthy patients is generally more dif- ficult than evaluating therapy for established disease because the time horizon to the clinical manifestation of disease is generally long many decades in the young. Thus, it is difficult, perhaps impossible, to assess long- term effectiveness in terms of survival or qual- ity-adjusted life-years (QALYs) or associated costs because of increasing uncertainty about outcome the further one tries to look into the future. Furthermore, the principle of discounting, which places relative emphasis on current costs and benefits while deemphasizing downstream costs and benefits, creates disadvantages for prevention because costs of- ten accrue in the present while the benefit may only be fully realized long into the future. These methodologi- cal challenges notwithstanding, prior AHA statements have highlighted the public policies, community ef- forts, and pharmacological interventions that are likely to be cost-effective and, at times, cost-saving preven- tion tactics compared with common benchmarks. For example, robust evidence suggests that both antihy- and statin therapy,S5-7 S5-9 par- ticularly with low-cost generic drug formulations, are high-value interventions across a wide spectrum of risk and age strata. The incorporation of the value category into clini- cal practice guidelines is one of several considerations in medical decision-making and resource allocation. Clinicians, researchers, and policymakers must con- tinue to place cost-effective analyses in the proper context, extracting key value determinations while acknowledging the challenges in fully characterizing and incorporating the downstream benefits of a given therapeutic prevention tactic. Further research and methodological advances are needed to comprehen- sively characterize the full spectrum of benefits pro- duced by the prevention approach, thereby rendering cost-effectiveness assessments more consequential to clinical practice. 