NICE has recommended rivaroxaban as a clinically and cost-effective option for treating pulmonary embolism (PE) and preventing recurrent deep vein thrombosis (DVT).
The independent body, which is responsible for driving quality improvement and excellence in the health and social care system, has issued draft guidance on the oral anticoagulant to consultees for appeal.
People with suspected PE are usually treated immediately with drugs that help to prevent the blood from clotting, most commonly with injections of low molecular weight heparin (LMWH). When the diagnosis has been confirmed, an oral anticoagulant such as warfarin is used.
A person’s risk of recurrent DVT or PE, as well as risk of bleeding, determines the duration of treatment. It typically lasts for six months or more, although people who are at high risk of recurrence may be given indefinite treatment with anticoagulants to prevent further episodes.
Thanks largely to the ageing population, it is estimated that there will be over 50,000 cases of acute DVT in England and Wales each year by 2016.
NICE believes rivaroxaban is an effective alternative treatment for DVT and PE, claiming it would also reduce costs. It has a UK marketing authorisation for the treatment of DVT and PE, and prevention of recurrent DVT and PE in adults.
“The committee heard from the patient expert that the regular monitoring and dose adjustment needed with warfarin, which needs regular visits to hospital or GP appointments, can be costly and inconvenient, and means some people might have to take time off work,” said Professor Carole Longson, NICE Health Technology Evaluation Centre director.
“Also, because warfarin has many drug interactions, it may be unsuitable for people with comorbidities. In addition, the committee heard that warfarin has various food interactions which often require people to adjust and monitor their diet and lifestyle.
“Rivaroxaban therefore represents a significant potential benefit for people with PE and DVT because it avoids the need for initiation with heparin and the subsequent transition to warfarin.”
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