The guideline panel considered that moderate costs were associated with PSM resource requirements, owing mainly to the costs of the point-of-care monitors and testing supplies and the more frequent INR testing that is generally used with PSM. The likelihood of PSM being cost-effective varied, with 1 modeling study indicating that PSM is likely to be cost- effective compared with usual care,74 whereas 1 RCT concluded that PSM is unlikely to be cost-effective.75 Most panel members also believed that PSM implementation would result in reduced health equity for patients in lower socioeconomic classes and those with cognitive problems and poor manual dexterity. The acceptability of PSM to major stakeholders varies but is probably feasible to implement. However, a substantial investment in patient training (even more so than with PST) 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 and VKA dose adjustment by patients at home over other INR testing approaches (including PST) for patients receiving VKA maintenance 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 and patients being able to make independent decisions about VKA dosing based on INR results. The panel determined that PSM was superior to PST, as it has shown reduction in mortality. Although the panel agreed that a strong recommendation in favor of PSM was warranted based on the available evidence, in settings where resources are limited or when patients are not willing or able to perform PSM, system decision- makers or individual patients may choose against PSM. 