Proportion of Direct Acting Oral Anticoagulants (DOACs) not prescribed as edoxaban or generic apixaban

Below are the database queries which are used to create this measure. These are run against a copy of the BSA prescribing data which we store in Google BigQuery. We're working on making our BigQuery tables publicly available at which point it will be possible to run and modify these queries yourself. But even where code and database queries are not directly useable by others we believe it is always preferable to make them public.

Description Percentage DOACs items not prescribed as edoxaban or generic apixaban
Why it matters In January 2024 the NHS in England released updated commissioning regulations for DOACs, which state:

For patients commencing treatment for Atrial Fibrillation (AF): subject to the criteria specified in the relevant NICE technology appraisal guidance, clinicians should use the best value DOAC that is clinically appropriate for the patient.

Table 1 provides the available DOACs ranked from highest to lowest best value according to the November 2023 Drug Tariff and confidential framework prices. If the highest ranked best value DOAC (generic apixaban) is contraindicated or not clinically appropriate for the specific patient then, subject to the criteria specified in the relevant NICE technology appraisal guidance, clinicians should then consider the next highest ranked DOAC (edoxaban) and so on until an appropriate treatment is identified.

Overall rank DOAC Notes
1 (Best value) generic apixaban Best value twice a day treatment
2 Edoxaban (Lixiana®) Best value once a day treatment
3 Rivaroxaban (Xarelto®)
4 Dabigatran (Pradaxa®)
5 Eliquis® (branded apixaban)

The NHS England National Medicines Optimisation Opportunities for 2023/24 identify using best value direct-acting oral anticoagulants as an area for improvement.

Please note: OpenPrescribing.net measures have a consistent way of visualising measures, where 'lower is better' and therefore in this case we show the proportion of DOACs which are NOT prescribed as edoxaban or generic apixaban.
Tags Cardiovascular system, Standard, Cost Saving, National medicines optimisation opportunities
Implies cost savings No
Authored by richard.croker
Checked by andrew.brown
Last reviewed 2024-01-16
Next review due 2026-01-16
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(items) AS numerator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("0208020X0AAAAAA", "0208020X0AAABAB", "0208020X0AAACAC", "0208020X0BBAAAA", "0208020X0BBABAB", "0208020X0BBACAC", "0208020Y0AAAAAA", "0208020Y0AAABAB", "0208020Y0AAACAC", "0208020Y0AAADAD", "0208020Y0AAAEAE", "0208020Y0AAAFAF", "0208020Y0BBAAAA", "0208020Y0BBABAB", "0208020Y0BBACAC", "0208020Y0BBADAD", "0208020Y0BBAEAE", "0208020Y0BBAFAF", "0208020Z0BBAAAA", "0208020Z0BBABAB")
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(items) AS denominator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("0208020AAAAAAAA", "0208020AAAAABAB", "0208020AAAAACAC", "0208020AABBAAAA", "0208020AABBABAB", "0208020AABBACAC", "0208020X0AAAAAA", "0208020X0AAABAB", "0208020X0AAACAC", "0208020X0BBAAAA", "0208020X0BBABAB", "0208020X0BBACAC", "0208020Y0AAAAAA", "0208020Y0AAABAB", "0208020Y0AAACAC", "0208020Y0AAADAD", "0208020Y0AAAEAE", "0208020Y0AAAFAF", "0208020Y0BBAAAA", "0208020Y0BBABAB", "0208020Y0BBACAC", "0208020Y0BBADAD", "0208020Y0BBAEAE", "0208020Y0BBAFAF", "0208020Z0AAAAAA", "0208020Z0AAABAB", "0208020Z0BBAAAA", "0208020Z0BBABAB")
 GROUP BY month, practice_id
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