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NHS procurement deal set to expand use of DOACs in atrial fibrillation


atrial fibrillation DOACs


NHS England says it has reached agreements with manufacturers on the price of direct oral anticoagulants (DOACs) which will enable clinicians to ‘dramatically’ scale up their use.

They have calculated that up to 610,000 extra patients with atrial fibrillation will now be able to benefit from the blood-thinning drugs.

The figure includes those newly diagnosed with atrial fibrillation or those with the condition in whom treatment is started but not those already on warfarin making a switch – which is a decision to be made in consultation with patients, NHS England confirmed.

New agreements reached with manufacturers come into force from January 2022 and will mean the use of DOACs can be expanded in line with the NHS Long Term Plan, NHS England chief executive Amanda Pritchard told delegates at an NHS Providers conference.

There is no detail as yet about the procurement deals reached but it is understood that they cover the four DOAC drugs currently recommended by NICE.

‘The agreements struck by NHS England will save thousands of lives and prevent many more people suffering the debilitating effects of strokes by making this treatment available to hundreds of thousands more patients,’ Ms Pritchard said.

‘The health service now has a proven track record of striking deals with manufacturers to ensure patients in England get cutting-edge care at a price which offers best value for taxpayers.’

In updated guidance published in April, NICE recommended that for men with a moderate risk of stroke, anticoagulation with a DOAC should be considered with apixaban, dabigatran, edoxaban and rivaroxaban all being recommended options. There is also technology appraisal guidance on the medicines which needs to be taken into account.

NICE has told Pulse that they were aware that procurement of direct acting anticoagulants for use in the NHS was ongoing while the guideline was being developed and they would consider whether the recommendations need to be reviewed in light of revised prices.

NHS England said the expanded use of DOAC treatment as a result of the procurement deal would help to prevent 21,700 strokes and 5,400 deaths over the next three years.

In October, Pulse reported that the UK National Screening Committee has said that NHS England should wait for further evidence before rolling out screening for atrial fibrillation via PCNs

Up to £40m is also being invested in ‘Detect, Protect and Perfect’ pathway initiatives to identify people with undiagnosed atrial fibrillation.

Professor Martin Marshall, RCGP chair, said: ‘GPs are at the forefront of identifying, treating and monitoring patients who are at risk of stroke. Greater availability of DOACs on the NHS will help to protect at-risk patients from having a stroke, and has the potential to save lives.’

He added it was also positive that patients receiving DOACs require less monitoring by GPs or other members of our teams in comparison with other anticoagulation treatments.

‘This is both convenient for patients and should help to free up GP time to deliver care to other patients in need of our care. It is important that GPs have all of the necessary information to prescribe and monitor patients on DOAC treatment appropriately, to take account of these advancements.’

Professor Azeem Majeed, professor of primary care Imperial College London, said it was potentially good news because patients with conditions such as atrial fibrillation are not prescribed warfarin to reduce their risk of stroke.

‘If more people are placed on DOACs, this would reduce the number of strokes experienced by this group. As use of DOACs increases, we would expect to see less use of warfarin.’

He added that while there was currently a lack of detail, it was likely that GPs would have a bigger role in initiating use of the drugs.

READERS' COMMENTS [3]

Not on your nelly 18 November, 2021 5:00 pm

I’ve not initiated warfarin for years. Not sure this is news.

Paul Attwood 19 November, 2021 11:48 am

This is not news. For quite some time the costs of DOACs have matched the costs of warfarin plus the monitoring costs. Reduction of DOAC costs are to be welcomed.

Turn out The Lights 19 November, 2021 2:35 pm

Been using doac first line for years even with an anticoag clinic, covid and workforce issues mean we are unable to provide for an army of patients on warfarin anymore..NHSE behind the curve by a year or 5.