Evidence map›Paper›PMID 27234663›Full record

Trial reportJournal of general internal medicine2016

At-Home Versus In-Clinic INR Monitoring: A Cost-Utility Analysis from The Home INR Study (THINRS).

Ciaran S Phibbs, Sean R Love, Alan K Jacobson, Robert Edson, Pon Su, Lauren Uyeda, David B Matchar, writing for the THINRS Executive Committee and Site Investigators

Abstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of general internal medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Clinical service organisation for adults with atrial fibrillation.The Cochrane database of systematic reviews · 2024
    Pooled it
  2. Guideline
  3. Trial
  4. Article
  5. Article
  6. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Ciaran S PhibbsHealth Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA. CiaranPhibbs@va.gov.
Sean R LoveHealth Services and Systems Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
Alan K JacobsonJerry L. Pettis VA Medical Center, Research and Development Service (151), Loma Linda, CA, USA.
Robert EdsonVA Palo Alto Health Care System, Cooperative Studies Program Coordinating Center (151 K), Palo Alto, CA, USA.
Pon SuHealth Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
Lauren UyedaVA Palo Alto Health Care System, Cooperative Studies Program Coordinating Center (151 K), Palo Alto, CA, USA.
David B MatcharHealth Services and Systems Research Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
writing for the THINRS Executive Committee and Site Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEffective management of patients using warfarin is resource-intensive, requiring frequent in-clinic testing of the international normalized ratio (INR). Patient self-testing (PST) using portable at-home INR monitoring devices has emerged as a convenient alternative. As revealed by The Home INR Study (THINRS), event rates for PST were not significantly different from those for in-clinic high-quality anticoagulation management (HQACM), and a cumulative gain in quality of life was observed for patients undergoing PST.

objectiveTo perform a cost-utility analysis of weekly PST versus monthly HQACM and to examine the sensitivity of these results to testing frequency. PATIENTS/

interventionsIn this study, 2922 patients taking warfarin for atrial fibrillation or mechanical heart valve, and who demonstrated PST competence, were randomized to either weekly PST (n = 1465) or monthly in-clinic testing (n = 1457). In a sub-study, 234 additional patients were randomized to PST once every 4 weeks (n = 116) or PST twice weekly (n = 118). The endpoints were quality of life (measured by the Health Utilities Index), health care utilization, and costs over 2 years of follow-up.

resultsPST and HQACM participants were similar with regard to gender, age, and CHADS2 score. The total cost per patient over 2 years of follow-up was $32,484 for HQACM and $33,460 for weekly PST, representing a difference of $976. The incremental cost per quality-adjusted life year gained with PST once weekly was $5566 (95 % CI, -$11,490 to $25,142). The incremental cost-effectiveness ratio (ICER) was sensitive to testing frequency: weekly PST dominated PST twice weekly and once every 4 weeks. Compared to HQACM, weekly PST was associated with statistically significant and clinically meaningful improvements in quality of life. The ICER for weekly PST versus HQACM was well within accepted standards for cost-effectiveness, and was preferred over more or less frequent PST. These results were robust to sensitivity analyses of key assumptions.

conclusionWeekly PST is a cost-effective alternative to monthly HQACM and a preferred testing frequency compared to twice weekly or monthly PST.

Indexed as

AdultAgedAged, 80 and overAmbulatory Care FacilitiesAnticoagulantsCost-Benefit AnalysisDrug MonitoringFemaleFollow-Up StudiesHome Care ServicesHospitals, VeteransHumansInternational Normalized RatioMaleMiddle AgedProspective StudiesAnticoagulantsWarfarinanticoagulantsatrial fibrillationcost effectivenessheart valverandomized trials

Identifiers

PMID27234663
PMCPMC4978674

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.