To the Editor: The potential cost-effectiveness (CE) of adopting innovative procedures within a publically funded healthcare system is a recurring issue.1 Trans-catheter aortic valve insertion (TAVI) is not currently provided by the devolved National Health Service in Scotland, although a single high quality randomised controlled clinical trial (RCT) has demonstrated that TAVI is a clinically effective intervention for reducing the risk of death in older patients with severe aortic stenosis considered unfit for standard surgery.2 The recently published CE analysis of TAVI reports an incremental …