Own v. Rent INR Machine?

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cewilk

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Hey there everyone! Like many of you probably reading this, I have been home testing for a while now (4.5 years) and have been using the Coaguchek XS the entire time. I haven’t had any complaints with the machine, but at this point I feel like it may be less expensive over time to just purchase my own machine and supplies. Before I hit my annual insurance deductible, I pay Lincare ~$120/month for machine rental and supplies and I also pay my PCP’s office ~$80/month when my INR result gets called in. A nurse calls me to tell me my INR is in range and there isn’t anything else I need to do, and I get charged $20 every time which I’m getting tired of. I feel very confident adjusting my own warfarin dose if I am indeed too low or too high and I don’t really feel I need a nurse to call and tell me what to do at this point (no offense to any nurses out there 😄).

My question is who owns their own INR machine and purchases their own test strips out of pocket and do you also self manage your Coumadin dosing? Any pro/con insights? Also, any other machines besides the Coaguchek that people know about? It seems to be the main one everyone is using.

Thanks for any info and/or advice!
 

cewilk

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Do you have the Coaguchek XS? Where did you purchase your machine and where do you usually buy your strips?
I get a 90 day supply of 10mg warfarin but alternate dosages between 10-15mg depending on the day, I just use a pill cutter when I need a 5mg amount.
 

Protimenow

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I have a CoaguChek XS and three Coag-Sense machines. I'm about to get rid of one. My newest is the PT2, a really nice (and accurate) device. I bought the CoaguChek XS on eBay. Keep checking frequently - occasionally one is available for a pretty good price.

When I was using the CoaguChek XS, I bought my strips on eBay. There are medical supply vendors who will sell meters and strips, but you may need a prescription to buy them.

A few more things -- DON'T change your dose daily, based on your test results. You DON'T have to test more than once a week, unless your INR is below two and you want to be sure that it's in range.

Try to keep the same dose daily. The INR today reflects the warfarin you took three days ago - adjusting doses too frequently will only wind up with bad results.

As far as dosing, it would be better to create your dose from smaller doses. For example, I'm now taking 7 mg/day. I created this using 1 1/2 4 mg pills plus a 1 mg pill. Now, I'm doing it with one 5 mg and 1/2 of a 4 mg pill.

If you need 10 mg, just take two 5 mg pills. You can get a much finer number with smaller doses than you can by trying to break 10 mg into doses smaller than 5.

Again - try to keep the daily dose the same. Don't drive yourself nuts (and waste strips) by testing more often than once weekly. If you can, get smaller dose warfarin to make up your larger daily dose. Finally - your meter's reading does NOT reflect the dose you took YESTERDAY - it takes a few days for the warfarin's effects to show up in your INR.

And, again, I bought my CoaguChek XS on eBay. Make sure that your vendor has a high rating and will accept returns if the meter doesn't work. If you choose to go with a CoaguChek XS be certain that the strips for sale aren't part of the recall. And if you want to buy a Coag-Sense, send me a private message - I have one for sale.

I hope this answers your questions.
 

jmo3

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I'm glad you posted this as I've been thinking about doing the same for some time. Are you going to buy your machine online?
 

pellicle

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My question is who owns their own INR machine and purchases their own test strips out of pocket and do you also self manage your Coumadin dosing? Any pro/con insights? Also, any other machines besides the Coaguchek that people know about? It seems to be the main one everyone is using.
Me
Yes I self dose
No cons only pros
I use coaguchek because outside if of the USA the strips are the easiest to obtain
Tips:
 

Protimenow

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To answer the first question -- YES. I like the PT2 a lot. Seven years ago, I had a TIA (minor stroke) because I trusted my InRatio too much. It was telling me my INR was 2.6. In the hospital, after my TIA, the INR was measured at 1.7. I decided to test meters against the labs - I tested InRatio, CoaguChek S and CoaguChek XS, Protime 3, and Coag-Sense. In my testing, I determined that the Coag-Sense was most reliable - giving an INR the same as the labs, or slightly lower. The CoaguChek XS was also reliable for INRs below around 4 (if I ever let my INR get that high) and was consistently higher than the labs. In fact, it almost looked as if the lab values were teh average of the Coag-Sense and the CoaguChek XS.

The price of the PT2 is about the same as the price for a retail CoaguChek XS. HOWEVER - the 'classic' Coag-Sense has been on eBay for about $150 or so. I wouldn't be surprised if the vendor will reduce the price if you send a message and an offer for it. He seems to have many units and will probably jump at the chance of selling one.

I've been using my 'Classic' since March 2013. I got the PT2 at the end of March, and use it for most tests, but the 'Classic' worked well for all those years, and, I'm sure, would continue for many more years. These meters - CoaguChek XS and Coag-Sense are designed not only for self-testing, but for doing thousands of tests at clinics and doctor's offices, so I wouldn't be concerned about how long a meter would last - at one test a week, you can probably figure at least 20 years of use of you want to match what a busy anticoagulation clinic probably does in a month.

There is at least one advantage to the Classic that the PT2 can't match. It starts quickly (the PT2 takes a minute or two to load the firmware and get ready for testing). If you don't want to buy a new PT2 (or can't find a great deal), a new Coag-Sense classic can be a very reliable meter for many years to come.

One other thing--I found at least one 'bundle' at a medical supplier that gives you a PT2 meter free if you buy four boxes of strips. There may be enough people here who may want to buy an extra box of strips, and this can bring down the actual price -- or you can sell the extra strips on eBay and probably recover most of the cost of the meter.
 
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leadville

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Thanks for the detailed reply, it's good to know the XS performed well in you testing.
i very rarely travel north beyond 4.0

My current weapon of choice is the XS that i test with weekly

The PT2 does looks great tho (y)
 

Protimenow

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The XS is more well known and more widely available. There may be more variance from lab scores the higher your INR goes. Keeping it below 4 should be fine. If your INR wanders into the low 2s, you may want to raise it a bit -- just to be certain that it's above 2.
 

Keithl

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Apr 20, 2019
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The challenge I the US is if you want a new machine you need a prescription so if your doctor will write one you can get a new machine. eBay is an option for the CoagCheck XS, but the CoagSense PT2 is too new to find on eBay. The medical practices of my hospital will only go through a service. I did get my own machine, but I had to jump through hoops to get it as my doc would not write a script. I am hoping to convince my cardio with my spreadsheets that I can do this without the service or let my primary doc manage me as I am sure she will let me do it as she has been my doc for over 10 years and knows me well.

In the US I am convinced money is paying a part in convincing doctors to use the services as I am sure they get a kick back.
 

mina

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I purchased my own meter, without a prescription. I purchase my own strips, also without a prescription. I call in my INR to my coag clinic, mostly as a formality. If my INR is off they often ask what I'd like to do. I'm young and have been self-testing for almost 5 years too.

The initial cost of the meter is high, but they last a long time so you're right about cost savings. The only cost to me at this point is the strips, which are about $5 each if you buy a 48 pack. My coag clinic does not charge for me calling in my INR. My old one did not either. Is it normal for coag clinics to charge is the US?

I get my supplies from Dakota Medical. It's been fine. They often have $10 off coupons, ship for free, and have been the lowest price whenever I've looked. No prescription needed. I have a Coagucheck XS too. (I'm not a Dakota Medical sales person and I've often wondered where they get their supplies, but the things I receive seem fine. I offer just to give a name of a place.)

I love this approach. I can't stand the idea of paying some company for me to report my INR to them so that they can report it to my coag clinic when I can do it myself. Such waste. I've wondered about completely self-managing, but I don't mind calling the coag clinic myself and haven't asked my cardio about it. I'm not entirely positive that he'd still write my warfarin rx if I didn't call the coag clinic at least once in a while (as a risk management measure, probably - again, I'm not charged for using my coag clinic, and my insurance is not either). The coag clinic is out of my cardio's office.

Good luck! Going on your own works great for most people it seems. The only risk is that something goes wrong with the machine or the strips get recalled (as happened recently) and you don't have some company making sure you get the strips/machine replaced. To hedge against this I do typically take one lab test to compare with my meter with each set of strips I get.
 

Protimenow

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The Coag-Sense PT2 IS very new. However, you can buy its predecessor, which is an excellent meter, and one that I've used for five or six years - on eBay, for less than $200 - and these are supposed to be new. It's larger than the PT2 (less portable), but very easy to use.

I've seen one medical supplier that offers a PT2 for free if you buy 3 or 4 (I think it's four) boxes of strips. The meter comes with the strips. The total cost is roughly the cost of the meter. You may even be able to sell two or three extra boxes, and further reduce your actual cost.

I don't work for Coagusense, and they probably aren't getting a penny off the sales of the original meter on eBay, but I often say that the Coag-Sense - either what I call the 'Classic' or the PT2 are my meters of choice.

Also, FWIW, studies have shown that people who self-test have INRs in range more of the time than patients who rely on clinics to do the infrequent testing.

Mina - I've gone as long as six months between blood tests. I used to do monthly blood tests to compare my meter's results. These meters - CoaguChek XS or Coag-Sense - are made to be used in clinics and doctor's offices for hundreds or thousands of tests each month. I've gotten at least four ERRONEOUS tests from labs in the lasty 12 months. I've gotten to the point where I trust my meter more than I trust the labs. HOWEVER, if you have any lack of confidence in your meter, it may be well to get a blood draw every few months.
 

trav

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Aug 11, 2019
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I got my meter through my insurance, who used Alere (recently changed to Acelis Connected Health) to supply my meter and submit my results online to my doctor. I originally got my strips through a company contracted through my health insurance, but after my employer switched health insurance companies I decided to buy my strips on my own. Now I need to find another place to get them from or go back to the insurance route. (See below for what happened).

I get my supplies from Dakota Medical. It's been fine. They often have $10 off coupons, ship for free, and have been the lowest price whenever I've looked. No prescription needed. I have a Coagucheck XS too. (I'm not a Dakota Medical sales person and I've often wondered where they get their supplies, but the things I receive seem fine. I offer just to give a name of a place.)
If you don't mind me asking, when did you last order from them? I have ordered from them in the past and everything went great. After placing an order in late July and asking to see if my strips shipped yet, they have not answered any of my messages I sent them a week after the order and still have not yet received my strips (2 weeks plus since my order). You can PM me if you want.
 
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Protimenow

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I just looked up Dakota Medical -- was this Dakota Medical Supplies in MN?

Strangely, their image for POC testing showed the older model Coag-Sense meter, but it doesn't look as if they carry it.

trav - I hope you get your strips from them soon, and weren't ripped off....
 

trav

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Aug 11, 2019
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Yep, thats them. If you click on that image they have coaguchek xs meter and strips available to buy.

Anyways I already filed a dispute with my credit card.
 

pellicle

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Hi

I purchased my own meter, without a prescription. I purchase my own strips, also without a prescription. I call in my INR to my coag clinic, mostly as a formality. If my INR is off they often ask what I'd like to do. I'm young and have been self-testing for almost 5 years too.
ideal ...


The initial cost of the meter is high, but they last a long time so you're right about cost savings.
agreed, I've had mine (Coaguchek XS) about 8 years now, so even if we only count the weekly tests (and its done much more) it would be adding $1.20 per test

I get my supplies from .... No prescription needed
similar ... in Australia and in the EU

...I love this approach. I can't stand the idea of paying some company for me to report my INR to them so that they can report it to my coag clinic when I can do it myself.
and as a bonus when you travel you can just take it with you :)

I used to do half yearly comparisons with a lab, but haven't done that for the last 3 or so years now (they were all within 0.2 anyway)
 

tom in MO

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...My question is who owns their own INR machine and purchases their own test strips out of pocket and do you also self manage your Coumadin dosing? Any pro/con insights? Also, any other machines besides the Coaguchek that people know about? It seems to be the main one everyone is using.

Thanks for any info and/or advice!
I live in KC. My nurse said that I may own my INR machine, because lots of places provide the machine for free and charge for the strips. Turns out she was right. So you may not need to purchase one. I asked the strip/meter provider who owns the machine me or them since I didn't pay for it. The lady on the phone told me it's mine and they provide it for free since they make their nut on selling the strips.

My strips cost $450 from insurance's designated provider. That covers my deductible for the year, which I'd have to pay anyway. After that, it's just co-pay and when I did the math, the total is a little less than buying the strips from a provider that is not preferred by insurance.

My cardiologist group practice used to have free coumadin clinic service, but when Medicare allowed doctors to charge (2018 I think) they started charging each time I called in. I complained to the practice and my insurance company to no avail. I told my cardiologist that I would only call in when I needed help. He didn't like it but that's been working for about a year and a half. The nurses in the clinic don't like it either and I have to explain the few times I ask for help, but they live with it.
 

Protimenow

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A lot of people on this forum self-manage our dosing. It's not difficult to do. I'm sure you can get suggestions on this forum.

A few tips: try to establish a daily dose that keeps you in range. If your INR makes a major change, consider whether diet may have changed, or if you take antibiotics, or have done anything else that may have made a change in your INR.
Don't overreact by making large changes to your dosing (unless your INR drops below 2.0). Warfarin works slowly - the result of today's dose won't be fully expressed for a few more days.

If you don't take the same dose daily, your INR may be different, depending on which day you take it.

It's YOUR life, and you have more interest in carefully managing the INR (and other things in your life) than a busy clinic or doctor's office does.

I've been self-managing my INR for years. The only time I ran into trouble was when I use an InRatio meter (now pulled from the market) that was reporting a 2.6 when the actual value was 1.7. My meter of choice is the one manufactured by Coagusense (Coag-Sense, and PT2 meters), although the CoaguChek XS has a much larger user base, and has a long record of reliable tests. And, please, don't always trust the labs - I have found quite a few instances where they were just plain wrong.

If you have questions about self-management, in addition to getting suggestions at this site, there is also a chart or two, somewhere on this site that can help you to manage it.

Of course, if you'd rather have your doctor or a clinic manage your dosing, let them do it.
 
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