Yet, our statement refers strictly to the UK NHS and is underpinned by the cost-effectiveness analyses that informed the National Institute for Health and Care Excellence (NICE) guidelines recommendation3: the NICE MitraClip model3 and Shore 2020.4 Although Armoiry and Connock state that in the UK ‘cost-effectiveness is a key criterion to judge recommendation’ and although at current device cost, in the UK NHS, the incremental cost per quality-adjusted life-year (QALY) gained for TEER in secondary mitral regurgitation was significantly above the £20 000 threshold in both NICE analysis and Shore 2020, the NICE guidelines do recommend TEER in secondary mitral regurgitation; the recommendation (‘consider TEER’) is of similar strength with the European and American guidelines recommendation (class II). The NICE incremental cost per QALY gained threshold refers to a strong recommendation (‘offer TEER’), equivalent with a European and American recommendation class I. However, the existent clinical effectiveness evidence prevents all guidelines from making a strong recommendation. An analysis of the cost-effectiveness of transcatheter mitral valve repair for people with secondary mitral valve regurgitation in the UK.