NHS England is to review its commissioning recommendations for cardiovascular disease (CVD) after a cheaper direct oral anticoagulant (DOAC) has appeared on the market, Pulse PCN understands.

Under the 2022/23 Network DES, NHS England had incentivised PCNs to start prescribing edoxaban to new patients and consider switching patients over, following a procurement deal with the manufacturers.

But edoxaban – at £49 per patient per month – is no longer the cheapest DOAC on the market, with apixaban now being the lowest priced, at £15.73 – £16.19 per patient per month.

NHS England did not comment on the development, however Pulse PCN understands it is reviewing its commissioning recommendations in light of the change in the market, with an update to be issued in due course.

The wholesale switch to edoxaban was encouraged under the Investment and Impact Fund (IIF) indicator CVD-06 in March 2022, with PCN directors concerned that the workload involved would be too great.

In further updates to the contract, NHS England reduced the lower and upper thresholds for the CVD-06 indicator from 40% and 60% to 25% and 35% respectively.

Other clinical directors expressed concerns around the IIF indicator incentivising the use of a particular drug based on cost – although this is allowed under NICE guidance.

GP finance expert Dr Gavin Jamie at the time estimated the updated indicator would mean an average PCN of 50,000 patients would still need to switch around 180 patients onto edoxaban, yielding on average about £69 per patient switched.

Pulse PCN this week contacted all 42 integrated care boards (ICBs) to confirm if they would be encouraging their PCN practice to switch patients onto apixaban.

Of those that responded, only Shropshire, Telford and Wrekin ICB said it is encouraging prescribing apixaban to all new patients but would not be advising a wholesale switch.

It added that it stopped actively recommending a switch to edoxaban in 2022 after the first the first court case over the patent challenge ruled in favour of the generic manufacturers of apixaban.

It said: ‘Currently, we do not believe that switching from edoxaban to apixaban is good use of clinical time whilst primary care is so stretched.’

Daiichi Sankyo, the manufacturer of edoxaban, and Bristol Myers Squibb, the manufacturer of apixaban, have both been contacted for comment.

This article first appeared on our sister title Pulse PCN.