PREVIEW: Proportion of rivaroxaban and apixaban not prescribed generically by all Sub-ICB Locations

Why it matters: In September 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 September 2024 and confidential framework prices. If the highest ranked best value DOAC (generic apixaban or generic rivaroxaban) 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 (Joint best value) Rivaroxaban (generic)
Apixaban (generic)
Best value once a day treatment
Best value twice a day treatment
2 Edoxaban (Lixiana®)
3 Xarelto® (branded rivaroxaban)
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.

This measures shows the percentage of prescriptions for rivaroxaban and apixaban which were not prescribed generically.

Description: Percentage of rivaroxaban and apixaban not prescribed generically

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Sub-ICB Locations are ordered by mean percentile over the past six months. Each chart shows the results for the individual Sub-ICB Location, plus deciles across all Sub-ICB Locations in the NHS in England.

View measure for NHS England combined →



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