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Correspondence on 'Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation does need confirmation' by Cohen et al
  1. Xavier Armoiry1,2,3,
  2. Martin Connock3
  1. 1 Public Health department / UMR CNRS 5510 Mateis, Claude-Bernard University, Lyon School of Pharmacy (ISPB), Lyon, France
  2. 2 Pharmacy Department, Hôpital Edouard Herriot, Lyon, France
  3. 3 Warwick Medical School, University of Warwick, Coventry, UK
  1. 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}

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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.

We were …

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  • Contributors MC and XA drafted the first version of the letter.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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).

  • Provenance and peer review Commissioned; internally peer reviewed.

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