17 Jun 2014 Posted in News Release By Press Office
“As a member of the NIC, the ABPI is pleased to see the timely release of its first consensus statement. This supports the local implementation of NICE guidance on the management of atrial fibrillation, which is also launched today, and is very welcome input to this important issue.
“Despite licensed novel oral anticoagulants (NOACs)1 being approved by NICE as being effective, reliable and with favourable safety profiles compared to warfarin, there are still barriers preventing their use.2 The consensus statement aims to support clinicians to understand the barriers and also ensure that they do not prevent patients, who would benefit from these medicines, having access to them. To date there has been a relatively low uptake of NOACs in England, particularly compared with other European countries, and this falls behind NICE’s own projections for these new treatments and means that patients are missing out.
“As the epidemic of atrial fibrillation continues to increase, the consensus statement quite rightly calls for these medicines to be made available for prescribing within their licensed indications, and to be automatically included in local formularies without further adaption of guidance at a local organisation level. It also recognises that there needs to be better clinician and patient engagement so that patients can be actively involved in decisions about their treatment options and agree the therapy that is best for them. The new patient decision aid, also launched today, should help with this.
“As highlighted in the consensus statement, we need to agree protocols across primary and secondary care for initiation of NOACs . An urgent review of local arrangements is required alongside the development of policies so that NOACs can be better implemented into local care pathways. Healthcare professionals must act on their duty to help patients make decisions about their treatment based on an understanding of the likely benefits and risks rather than on misconceptions.”
1Licensed NOACs medicine - dabigatran, rivaroxaban and apixaban - have been approved by NICE as options for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF).
Use of aspirin: Some clinicians believe that aspirin is safer than oral anticoagulation. New evidence shows this not true, and aspirin does not work as well as oral anticoagulants in preventing stroke in people with atrial fibrillation (AF).
Variation in usage: This is as a result of NOACs not being on local formulary or restricted access to patients and clinicians due to NICE guidance being reinterpreted rather than implemented.
Perceived Cost: Cost is a perceived barrier to the use of NOACs . NICE has concluded that they are cost-effective and must be available to patients within their licensed indications.
Adherence: Because the NOACs have predictable pharmacokinetics, coagulation control does not need to be monitored. There is some concern that the lack of monitoring with the NOACs might lead to poor adherence. However, programmes for patients to help support adherence may be available from the NOAC manufacturers. Pharmacists also offer support for patients on adherence through NHS services such as medicines use reviews.
Inadequate local care pathways and clinical/patient engagement: Clinicians are not getting the right education on the risks/benefits for example in reversibility and there is no clear accountability locally for implementation. Patients are also not routinely part of treatment decisions.
The NICE Implementation Collaborative was set up in 2012 to identify barriers to the implementation of NICE guidance, with the aim of ensuring that patients get quick and more consistent access to approved treatments. It is a partnership between the NHS, the life sciences industry, healthcare professional bodies, key health organisations and the public.
The ABPI represents innovative research-based biopharmaceutical companies, large, medium and small, leading an exciting new era of biosciences in the UK.
Our industry, a major contributor to the economy of the UK, brings life-saving and life-enhancing medicines to patients. Our members supply 90 per cent of all medicines used by the NHS, and are researching and developing over two-thirds of the current medicines pipeline, ensuring that the UK remains at the forefront of helping patients prevent and overcome diseases.
The ABPI is recognised by government as the industry body negotiating on behalf of the branded pharmaceutical industry, for statutory consultation requirements including the pricing scheme for medicines in the UK.
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