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To the Editor: we have read with considerable interest the paper by Cohen et al1 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 al1 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 …
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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