The guideline panel considered that moderate costs were associated with PST resource requirements, owing mainly to the costs of the point-of- care monitors and testing supplies and more frequent INR testing generally used with PST. The likelihood of PST being cost- effective varied, with 1 review, 1 RCT, and 1 modeling study indicating that PST is likely to be cost-effective compared with whereas 2 other reviews concluded that PST is unlikely to be cost-effective within accepted standards46,47 and that PST implementation would probably result in reduced health equity for patients in lower socioeconomic classes and those with cognitive problems and poor manual dexterity. Because some patients are unwilling to perform PST, the panel determined that the acceptability of PST to major stakeholders varies, but the intervention is probably feasible to implement, though a substantial investment in patient training and testing equipment is necessary. Conclusions and research needs for this recommendation. The guideline panel determined that there is low certainty evidence for a net health benefit from using point-of-care INR monitoring at home by the patient over other INR testing approaches (except for PSM, see recommendation 4) for patients receiving VKA mainte- nance therapy for treatment of VTE. This benefit is conditional upon patients and health care systems being able to afford and manage the self-testing equipment. In settings in which resources are limited or when patients are not willing or able to perform PST, deviation from this suggestion is appropriate. Furthermore, systems using PST should be able to perform regular external quality assessment of the testing equipment and patient s ability to obtain accurate INR results. 