Best value direct oral anticoagulant (DOAC) prescribing
In line with NHS England Best value DOAC recommendations switch, all clinically appropriate, existing edoxaban patients with non-valvular atrial fibrillation (AF) to either generic apixaban or generic rivaroxaban.
Content is available on the PQS 24/25 webpage, to support the management of newly diagnosed AF patients or those prescribed branded Apixaban or Rivaroxaban.
As per the NHS England commissioning recommendations for the national procurement for direct-acting oral anticoagulants (DOACs), generic apixaban and generic rivaroxaban offers best value treatment for atrial fibrillation.
Run the SystmOne search provided to identify existing patients prescribed edoxaban who are eligible for a switch to best value DOACs under the IPoC scheme:
Dorset SystmOne GPs> Best Value DOACs> Work to do: clinically review edoxaban for switch
Invite patients for a clinical review of their Edoxaban, using the template letters and text messages provided.
Where clinically appropriate, after a shared decision-making process with patients, recognising their preference in choice of either apixaban or rivaroxaban, switch existing patients prescribed edoxaban for non-valvular AF to either generic apixaban or generic rivaroxaban.
Where it is not clinically appropriate to switch patients to a best value DOAC from edoxaban, the patient should remain on edoxaban, but the relevant exemption code must be added to the patient record, which will remove them from the SystmOne search.
| Code | Term |
|---|---|
| XaLTs | Anticoagulant therapy stopped |
| Xad9s | Apixaban not tolerated |
| XadAI | Apixaban contraindicated |
| Xad9m | Apixaban adverse reaction |
| Xad9t | Rivaroxaban not tolerated |
| XadAK | Rivaroxaban contraindicated |
| Xad9n | Rivaroxaban adverse reaction |
| XaPT9 | Not suitable for switch to generic medication e.g. due to disability and self-administration of medicines e.g. visually impaired, explicit secondary care request to remain on edoxaban |
SystmOne search:
Dorset SystmOne GPs> Best Value DOACs> Work to do: clinically review edoxaban for switch
Template text message:
“NHS Dorset have asked GP teams to review the prescribing of Edoxaban in line with NHS England recommendations. Please book an appointment at the surgery when convenient to discuss this further”
For further details regarding the scheme please see the following document:
Incentivisation Pace of Change – Best Value DOACs in Primary Care FAQ
Incentivisation Pace of chance scheme in primary care: best value DOACs
Relative associated major gastrointestinal bleeding risk of best value DOACS – graphic
