Forecasting Model of Potential Savings In Prescribing of Direct-Acting Oral Anticoagulants

Abstract

Objectives: To forecast savings if general practitioners (GPs) in England adopt ‘price-sensitive prescribing’ practices for oral anticoagulant drugs (OACs) to treat atrial fibrillation. Methods: Imperial College Health Partners designed a model to forecast patient volumes and prescribing costs, based on National Health Service (NHS) Drug Tariff prices in January 2018, Office of National Statistics population projections, and data from the ePACT electronic prescribing and cost tool. A manufacturer rebate is currently available for the DOAC edoxaban. A Freedom of Information request to Clinical Commissioning Groups (CCGs) showed which organisations use it. Manufacturer rebates are not publicly available. In a previous value for money analysis we estimated that DOAC prices would need to fall by 29% to be as cost-effective as warfarin. Assuming that switching time was 4 months, warfarin costs include monitoring, OACs would be prescribed to maximum 2.2% of the GP-registered population, and DOAC cost would drop to £5 per pack off patent, we forecast potential savings from 2018/19 to 2026/27 if CCGs switched from their current DOAC to the cheapest. Results: Although in 2016/17, 112 (54%) of 208 CCGs took the edoxaban rebate, it was prescribed to only 0.3% (1.1 million of 335 million) patients receiving OACs. The per-pack price of edoxaban without rebate is £49.00 and would fall to £34.79 with 29% rebate. If the 54% of CCGs currently accepting the rebate took full advantage, in 2018/19 the saving in total OAC costs would be £94 million (17%), leading to a cumulative saving of £1,775 million by 2026/27. If all CCGs took the rebate and switched, the saving would be £135 million (25%) in 2018/19, reaching a cumulative £2,061 million by 2026/27. Conclusions: Increased rebate uptake and switching to the cheapest DOAC could lead to substantial prescribing savings for the NHS.