Kiwi yes I think you are making my point. It doesn’t have to be exactly the same outcome as the trial; this is an economic argument and works better in European countries because there is a single payer systems and people don’t change insurance. In the US, economic incentive is more focused on short term for insurance companies as people are switching insurance more of term (at least for the commercial insurance). You can argue Medicare is a single payer system for the elderly. They can easily compare two cohorts; one on V and one not on V and look at the last say 5 years and see how many CABG’s or PCI’s each cohort got (have to be pretty similar patient characteristics). I think with RWE mounting, even Germany will come on board, eventually. Just my opinion