OBJECTIVES: This analysis aims to quantify the potential drug budget impact of PCSK9 inhibitors in Ireland associated with various reimbursement scenarios dependent on the nature and severity of cardiovascular disease. METHODS: Age and gender adjusted prevalence estimates of ischaemic cardiovascular disease were calculated from Wave 1 of the Irish Longitudinal Study on Aging (TILDA). Subgroups examined included the single and joint prevalence of myocardial infarction (MI), angina, stroke and transient ischaemic attack, and history of >1 MI or Stroke. The proportion of patients above a recommended LDL-C threshold of 2.5mmol/L was informed by TILDA. The prevalence estimates obtained were applied to current national population statistics and multiplied by the annual cost of PCSK9 therapy in Ireland (€8,118 including wholesaler mark-up, dispensing fees and VAT). 100% PCSK9 uptake was assumed; this was explored in sensitivity analysis. RESULTS: The potential annual budget impact for the respective cohorts is as follows: any history of Ischaemic Cardiovascular Disease: €438 million; Angina: €221.6 million; MI: €185.5 million; Stroke: €65.4 million, TIA: €82.4 million; MI or Stroke: €237.4 million; ≥2 MI: €42.4 million; ≥2 Strokes: €11.4million; MI and Stroke:€12.8 million; ≥2 Major Events (MI or Stroke): €55 million. CONCLUSIONS: The potential budget impact associated with PCSK9 inhibitor therapy is substantial and should be considered in any decision to reimburse. Further research should be conducted to determine the cost-effectiveness of PSCK9 inhibitor therapy in the cohorts examined to support any reimbursement decision.