Roche seems to make ?two? models of each machine? according to my discussion with the Roche Representative and by phone with their support group, the machines are essentially the same and use the same test strips etc. The difference is that for home testing, the FDA requires changes in the software interface to the tester to try and prevent certain missteps that might be taken. There is also a significant price differential between the two machines. In my case almost a 50% decrease for the doctors device. Even though I am a physician, the insurance company would not pay for that device for me to do my own home testing because it had not been ?approved?. So, you could have come to my office and been tested with the less expensive machine and I would get paid to do the test, but on myself no reimbursement.
At this point let me tell you how I operate my machine with my background as a physician and a chemist. The test strips do not calibrate the machine or the strips, they only indicate that the machine is functioning properly. For a doctors machine, the controls need be run only once a day, mainly to assure the staff that the machine has not been dropped or damaged in some way from the previous day. Also, the figures for control test results encompass three standard deviations from the actual vaslues, which isa huge range. Thus, what I do is rarely do controls. When I reach the last strip in a series, I at the same time run a test with a new box of strips. So far, the results have also been within 0.1 second of each other. This is as best a control as you can get. I have a lab draw every three months to validate the results. What this means is that with the present coagucheck, I am able to do 11 tests from each box of 12 strips exclusive of the ?overlap test that I do. This allows me to deal with my erratic INR values with testing every three days.
The new device from Roche will have the controls built into each strip, probably similar to the three cuvette system of INR. Thus my method above will no longer work with the new machine.
To further confuse the situation, one of my physician friends tried to set up a Coaguchek clinic in his office. The patients did not like it compared to the lab draws and he discontinued the service. He gave me 3 boxes of 48 strips. I have for the past two months been doing daily testing. In spite of on a weekly basis either keeping the same dosage in spite of the INR, or ?tweaking? the dosage based on the INR, my fluctuations continue. I am most jealous of those of you who claim that your INR is the same regardless of the time interval from 1-6 weeks between testing. Personally, I think Coumadin is a drug with huge variations in response. If you think I?, mot frustrated by this, imagine what your busy attending doctor feels when the dreaded INR result crosses his desk, or the nurse says, ?what should I do about this??
