OBJECTIVES:: To estimate the budget impact of adding evolocumab to standard lipid-lowering therapy (LLT) (statins with or without ezetimibe) in high-risk patients from the Brazilian private healthcare system perspective. METHODS:: This analysis considered high cardiovascular (CV) risk patients, specifically, individuals with non-familial hyperlipidemia or heterozygous familial hypercholesterolemia (HeFH), with history of CV event in the previous year and uncontrolled LDL-C (≥160 mg/dL). The baseline CV event rate was derived from a retrospective database study (SIDIAP), with inclusion criteria similar to the Brazilian population. This analysis used the relationship between LDL-C lowering and reduced CV event rates observed in the Cholesterol Treatment Trialists' Collaboration (CTTC) meta-analyses. CV event costs (inflated to 2016 values) were taken from local published studies. The total budget impact was estimated as the difference between additional medication costs and reduced CV event and procedure costs associated with the introduction of evolocumab. The budget impact was also expressed per member per month, with respect to the total number of patients covered by the private healthcare system. RESULTS:: Across all private healthcare insurers in Brazil, adding evolocumab to standard LLT for the defined high-risk population leads to a yearly incremental cost of R$31 million. Adopting and utilizing evolocumab is expected to prevent 24% of the predicted CV events. Given the 48 million privately insured patients in Brazil, an additional expense of R$0.05 per member per month can be expected. CONCLUSIONS:: Treatment with evolocumab in high-risk patients unable to control LDL-C levels with standard LLT results in a predictable and limited budget impact from the Brazilian private healthcare system perspective. At a modest monthly cost increase per privately insured patient, the addition of evolocumab to standard LLT is anticipated to cause a significant reduction in the number of both fatal and non-fatal CV events and procedures.