Baron SJ, Wang K, Arnold SV, et al. - Researchers compared transcatheter mitral valve repair (TMVr) with guideline-directed medical therapy (GDMT) in terms of cost-effectiveness in heart-failure patients with 3-4+ secondary mitral regurgitation (SMR), by utilizing data from the COAPT trial, which showed reduced mortality and heart-failure hospitalizations and improved quality of life in relation to edge-to-edge TMVr using the MitraClip vs maximally-tolerated GDMT in heart-failure patients with 3-4+ SMR. For TMVr procedure and index hospitalization, the initial expenses were estimated to be $35,755 and $48,198, respectively. Despite significantly lower follow-up costs reported with TMVr vs GDMT, TMVr was associated with higher cumulative 2-year costs and the reason for this was the up-front cost of the index procedure. At a cost of $45,648, an increase in the life expectancy by 1.13 years and in quality-adjusted life-years (QALYs) by 0.82 years was estimated to be offered by TMVr in symptomatic heart-failure patients with 3-4+ SMR, on modelling intrial survival, health utilities, and expenses over a lifetime horizon, providing a lifetime incremental cost-effectiveness ratio of $40,361/life-year gained and $55,600/QALY gained. Based on current US thresholds, this is an acceptable economic value.