Authors' objectives: Around 1% of the 74,000 patients prescribed warfarin in Scotland are also in receipt of International Normalised Ratio (INR) self testing strips. There is considerable heterogeneity in the evidence base with respect to the indications for therapy, patient selection, the intensity of education and support provided and the frequency of testing. There is also variation in the format and quality of the 'usual care' comparison. Meta-analyses of randomised controlled trials (RCT) data in patients receiving long-term oral anticoagulation therapy with vitamin K antagonists report that self monitoring of INR reduces the rate of thromboembolic events, compared with usual care, without affecting the rate of major bleeding events or mortality. In subgroup analysis, self-management was more effective than self-testing. Analyses of outcomes by age and indication for therapy highlighted that there were reductions in thromboembolic events in those aged <55 years and in participants with a mechanical heart valve. Patient quality of life is examined in the clinical effectiveness literature as a secondary outcome. Where it is reported, the majority of studies record beneficial effects. Economic analyses suggest that in the UK healthcare setting, INR self monitoring is unlikely to be cost-effective when compared with usual care.

Authors' recommendations: Meta-analyses report that, for patients requiring long-term oral anticoagulation with vitamin K antagonists, PST or PSM of INR reduces the rate of thromboembolic events when compared with usual care without increasing the rate of major bleeding events or all-cause mortality. Certainty around this finding is reduced in view of a recent, large and well conducted multi-centre RCT, with long-term follow up, reporting no benefit in a comparison of PST with care in a specialist clinic meeting guidelines for high quality anticoagulation management. Health economic evidence is inconsistent between countries. Findings are likely to be highly specific to the healthcare structures which are in place and particularly the frequency of testing in usual care. UK economic analyses report that self-monitoring is unlikely to be cost effective.

Project Status: Completed

Year Published: 2013

URL for published report: http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_-_evidence_notes/evidence_note_50.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland, United Kingdom

Organisation Name: Scottish Health Technologies Group

Contact Address: Scottish Health Technologies Group, Delta House, 50 West Nile Street, Glasgow, G1 2NP Tel: 0141 225 6998

Contact Name: his.shtg@nhs.scot

Contact Email: his.shtg@nhs.scot

Copyright: Healthcare Improvement Scotland