Changes to Direct Oral Anticoagulant (DOAC) measure
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NHS England’s commissioning recommendations for direct oral anticoagulants (DOACs) have evolved significantly over the past few years, largely in response to the availability of lower-cost generic options.
Below is a brief timeline of how these recommendations have changed over time:
Timeline: NHS England Commissioning Recommendations for DOACs
- NHS England issued commissioning recommendations following a national procurement exercise to improve cardiovascular outcomes.
- Edoxaban was recommended as the first-line treatment for patients with non-valvular atrial fibrillation (AF), primarily on the basis of cost-effectiveness.
- Clinicians were advised to consider switching suitable patients from more expensive alternatives (such as apixaban or rivaroxaban) to edoxaban, unless there were clinical reasons not to do so.
- Following the loss of exclusivity for apixaban, generic versions became available on the NHS.
- The guidance was updated to reflect this shift: generic apixaban was now considered more cost-effective than edoxaban, leading to a change in prescribing preferences.
- With the release of generic rivaroxaban, NHS England further updated its recommendations.
- Both generic apixaban and generic rivaroxaban were now included in the most cost-effective options, depending on local pricing and availability.
- Edoxaban was no longer the first-line recommendation, having been overtaken on cost grounds by the newly generic alternatives.
In September 2024 we updated the OpenPrescribing DOAC measure to reflect the latest guidance.
Our new measure now shows the proportion of prescription items not prescribed as generic apixaban or rivaroxaban tablets. As always with our measures, we write them in a consistent way, so that “low is better”. We’ve also specified generic tablets, rather than all generic formulations, as there are now generic rivaroxaban capsules on the market, which at the time of writing appear to be more expensive than the corresponding tablet. Because the measure has changed to not include edoxaban, we’ve changed the URL, and so any bookmarks to the older measure will need to be updated.
We also hope to shortly release an additional measure, showing where branded apixaban and rivaroxaban (and generic capsules) are prescribed.
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