text: Correspondence on 'Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation does need confirmation' by Cohen et al | Heart
  http://orcid.org/0000-0003-1166-0453Xavier Armoiry1,2,3,
  Martin Connock3
  1 Public Health department / UMR CNRS 5510 Mateis, Claude-Bernard University, Lyon School of Pharmacy (ISPB), Lyon, France
  2 Pharmacy Department, Hôpital Edouard Herriot, Lyon, France
  Correspondence to Prof. Xavier Armoiry, Public Health department / UMR CNRS 5510 Mateis, Claude-Bernard University Lyon1, Lyon School of Pharmacy (ISPB), Lyon, France; xavier.armoiry{at}univ-lyon1.fr
  http://dx.doi.org/10.1136/heartjnl-2022-321179
  To the Editor: we have read with considerable interest the paper by Cohen et al 1 estimating the cost-effectiveness of the Mitraclip system in patients with secondary mitral regurgitation (SMR).
  Like other published works that adopted different healthcare perspectives, including the one by Baron et al,2 the cost-effectiveness analysis conducted by Cohen et al 1 was based on 2-year data from the Coapt randomised controlled trial (RCT).3
  Generating lifetime estimates of survival gain (1.57 years here) from the 2-year data of Coapt requires extensive extrapolation of about 13 years beyond observed data and >95% of benefit reported in the percutaneous repair (PR) arm accrues in the extrapolation phase rather than the observation phase.
  The observed source data used for extrapolation can therefore exert a profound influence on estimation of gained benefit from PR.
  Contributors MC and XA drafted the first version of the letter.
  Competing interests XA is a member of the steering committee of the Mitra-Fr Study, and reports consultancy work undertaken for WL Gore (no personal fees received).
  Madalina Garbi Alfredo Mariani
  Heart 2022; 108 1073-1073 Published Online First: 09 May 2022. doi: 10.1136/heartjnl-2022-321181
  David J Cohen Elizabeth Magnuson Gregg W Stone John G F Cleland
  Heart 2022; 108 1072-1072 Published Online First: 09 May 2022. doi: 10.1136/heartjnl-2022-321180
  Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation
  Heart 2022; 108 717-724 Published Online First: 25 Jan 2022. doi: 10.1136/heartjnl-2021-320005
  Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation: is confirmation needed?