NOAC prescribing varies 16-fold between CCG areas

The proportion of AF patients at high risk of stroke who are receiving anticoagulation with NOACs instead of warfarin varies 16-fold across England, a report suggests.

GPC prescribing subcommittee chair Dr Andrew Green: slow adoption of new drugs 'understandable'
GPC prescribing subcommittee chair Dr Andrew Green: slow adoption of new drugs 'understandable'

Use of NOACs for anticoagulation ranges from 4% in some CCG areas up to 70% in others - a 16-fold variance - according to a report based on 2015 data, launched at the House of Commons on Monday.

The report, from the Association of the British Pharmaceutical Industry (ABPI), also found that the UK came 18th out of 21 European countries for providing access to NOACs.

NOACs account for less than 10% of total anticoagulation in the UK, compared to 38% in Germany, which has the highest.

But leading GPs warned that the more widely-used warfarin is not an inferior option, and GPs should continue to offer patients the treatments they consider best for patients.

NICE revised its AF guidance in June 2014, and urged healthcare professionals to consider wider use of NOACs – including apixaban, dabigatran etexilate and rivaroxaban – as alternatives to warfarin.

Anticoagulation therapy

NOACs do not require routine monitoring of drug levels in the way warfarin does, making them a more convenient option for some patients – but they cost up to three times as much as warfarin.

GPonline has already revealed that a rise in NOAC prescribing helped fuel a 60% rise in primary care anticoagulant drug spending in 2015.

This huge rise in spending – which amounts to £84m – was responsible for 20% of the overall increase in drug spending for the year.

Data from the Sentinel Stroke National Audit Programme (SSNAP), referenced in the report, shows that less than half of patients admitted to hospital with stroke in 2015 were taking anticoagulants, and 28% were taking antiplatelet drugs alone – treatment no longer recommended.

Dr Andrew Green, chairman of the GPC clinical and prescribing subcommittee, said: ‘There is no doubt that aspirin is an ineffective stroke preventer, and AF patients at significant risk should be offered an anticoagulant. However "offer" is the important word as some will choose not to do so.

‘Many GPs are understandably wary about changing patients from a well-established and effective treatment to a newer one with uncertain long-term risks, and to imply that warfarin is an inferior treatment is simply wrong, and contrary to NICE guidance where it remains an option.

‘There are patients who find control with warfarin challenging, and these are likely to benefit from a NOAC, but I fully understand GPs’ cautious adoption of new treatments.’

Dr Berkeley Phillips, Medical Director of the ABPI, said: ‘We need to understand why variation exists across the NHS when it comes to using new and innovative medicines which help to prevent stroke.

‘Through the use of these medicines as part of optimising anticoagulation treatment, we have an opportunity to improve patient health and prevent thousands of patients from dying needlessly.’

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