For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. There was no difference in the percentage time out of INR range (adjusted odds ratios [ORs] for likelihood of being out of INR ; very low certainty) or days with incorrect adherence (fully adjusted OR for likelihood of nonadherence, 0.84 [95% CI, 0.55- between those receiving the daily lottery intervention and control groups. Harms and burden. Mortality (ARR, 8 more per 1000; very low certainty), PE/DVT (ARR, 26 more per 1000; very low certainty), and major bleeding (RR, 1.63 [95% CI, 0.33-8.09]; ARR 22 more per 1000 [95% CI, 24 fewer to 249 more]; very low certainty) were all higher in the daily lottery intervention group than in controls, but the CIs were extremely wide, including both appreciable benefit and great harm. Other EtD criteria and considerations. Resource require- ments for the daily lottery would be large because the use of an electronic medication monitoring system would be required for each patient, and the cost for monetary prizes averaged $3 per patient per day. Furthermore, the panel determined that health equity would probably be reduced by the intervention, key stakeholders would probably not find a daily lottery acceptable, and given the requirement for specialized equipment, the in- tervention is probably not feasible to implement in most settings. Conclusions and research needs for this recommendation. Given that no evidence supports the benefit of the lottery approach, the likely high costs, and the probable lack of acceptability and feasibility, the panel suggests against using the lottery. This recommendation should not be interpreted to mean that interventions aimed at improving anticoagulant adherence are not important. 