Comparison of DOACs for Atrial Fibrillation

Comparison tables are produced for prescribers and medicines management teams. They are designed to assist in prescribing and decision-making within a specific therapeutic area.

Several direct oral anticoagulants (DOACs) are licensed for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF). This comparison table allows prescribers and other healthcare professionals to easily compare the characteristics of these medicines. It has been prepared in response to the NHSE England National Procurement and Commissioning Recommendations published in January 2022.

This publication was updated in August 2022 to update guidance on use of DOACs in patients with AF with prosthetic heart valves. Further information was also added about use in extremes of bodyweight.

Monthly Horizon Scanning Report – April 2022

Monthly horizon scanning reports are designed to inform the NHS about new products, significant changes to product licenses, significant new guidance, and decisions that have been made by recognised bodies. 

This information is produced for use by NHS healthcare professionals. 

Cost Comparison Charts

Overview

The charts included within this report are organised by BNF classification (legacy) and show comparative costs at the NHS basic price1,2 (as of July 2022) for selected agents. Except where indicated otherwise, each chart shows the cost of 1 year3 of treatment at a commonly prescribed daily dose (shown in brackets). The doses given are not intended to imply therapeutic equivalence and for some BNF sub-classifications, such as angiotensin converting enzyme inhibitors (ACE inhibitors), the doses may vary according to indication. Additionally, in some therapeutic areas, for instance antibacterial drugs, the duration of treatment may differ from that shown. Primarily, this report focuses on costs related to prescribing in adults. There are however a few exceptions where products specifically for use in children are represented, such as in the emollient and Infant formulas sections.  Additional notes to highlight any relevant cost related information are also added where appropriate, to improve the clarity of the information presented.

Rationale for inclusion: the cost comparison charts (CCCs) aim to represent the diversity of products available; including the least expensive, most prescribed, higher cost products being prescribed and products with additional features.  The products included are furthermore considered in the context of national and local guidance and stakeholder formulary decisions. It is not possible to represent all pharmaceuticals within these charts.

Stakeholders (under password protection) can access the current version of the CCCs via our website in three formats: PDF, Word and Excel. The Excel version incorporates a more detailed comparison of contraceptives and allows charts to be split by BNF subsections in some instances.

References


1. NHS Business Services Authority (NHS BSA). Drug tariff.

2. NHS BSA. Dictionary of medicines and devices (dM+d).

3. 1 year in this instance is equal to 364 days (rather than 365) standardising 1 month as equal to 28 days.

Time Period

July 2022

Frequency

Quarterly

Drug Tariff Monitor

Overview

The purpose of this report is to present the predicted cost impact of category A, M and C drug tariff PartVIIIA price changes on primary care spending. The data is calculated by matching the ePACT2 prescribing data for the latest month available to the current prices listed in the NHSBSA Drug Tariff PartVIIIA. An adjustment is also made if necessary to the prescribing data of each drug to account for any difference in dispensing days between the 2 months. Data is presented at CCG and STP level.

If you have any queries about the content of the report please contact us at nuth.nyrdtc.rxsupp@nhs.net

Frequency

Quarterly

Data Period

April 2022 (Drug Tariff), February 2022 (ePACT2 Prescribing data)

Monthly Horizon Scanning Report – April 2021

Monthly horizon scanning reports are designed to inform the NHS about new products, significant changes to product licenses, significant new guidance, and decisions that have been made by recognised bodies. 

This information is produced for use by NHS healthcare professionals. 

Safer Medication Use – Opioids and gabapentinoids

Overview

Safer Medication Use is a bulletin series jointly produced by the Regional Drug and Therapeutics Centre and the Yellow Card Centre Northern and Yorkshire, which aims to promote safer prescribing. It discusses specific drug related safety problems, provides guidance to ensure safe, appropriate prescribing and raises awareness of adverse drug reaction detection and reporting.

The use of combination opioids and gabapentinoids is associated with an increased risk of adverse events. Gabapentinoid overdose is much more likely to be fatal when combined with opioids and there is a greater risk of gabapentinoid dependence in patients with a history of opioid use disorder.

There are limited circumstances when patients should be prescribed both an opioid and a gabapentinoid, and prescribers must carefully balance potential benefits against the risk of adverse effects from combination therapy. In such situations the opioid dose should be reduced before starting a gabapentinoid and the patient reviewed regularly. Treatment should be stopped if it is not effective or not tolerated but withdrawal of established opioids and / or gabapentinoid therapy should be done slowly to prevent discontinuation symptoms.

Postoperative patients who are prescribed long term gabapentinoids should be closely monitored for respiratory depression.