In an paper published in the Journal, Global Heart, Dr Mariachiara Di Cesare, a Senior Lecturer in Public Health, describes how non-vitamin K antagonist oral anticoagulants (NOACs) could be a cheaper and safer treatment for people who have atrial fibrillation (AF) and are therefore at high risk.
AF, which causes irregular and often abnormal heart rate, is linked with a higher risk of hospital admissions and premature death.
More than 37.5 million people are affected by AF with 58% suffering from it aged 70 and over.
These figures are set to increase with individuals in low and middle income families less likely to receive anti-coagulation treatment given the need for regular monitoring and the burden this presents on struggling health services.
Unlike other stroke prevention drug such as Vitamin K Antagonist (VKAs), NOACs do not require routine testing and have far fewer interactions.
They are safe, effective and cheaper to provide according to Dr Di Cesare.
“Once a drug gets onto this list health services in different countries need to make every effort to provide it to their citizens. In poorer countries the WHO would work with the governments and local stakeholders to ensure patients could access it. It’s a great achievement and more importantly represents a major step forward in reducing the burden of cardiovascular illness and death.” Dr Mariachiara Di Cesare, Middlesex University
As part of the World Heart Federation Emerging Leaders programme, Dr Di Cesare and her team provided evidence to World Health Organisation (WHO) about the efficacy and cost-effectiveness of using NOACs to prevent strokes in high risk patients.
The aim was to support with evidence the World Health Organisation WHO for the inclusion of the drug on its Model List of Essential Medicines.
Inclusion on this list cannot be underestimated says Di Cesare.
She said: “Once a drug gets onto this list health services in different countries need to make every effort to provide it to their citizens. In poorer countries the WHO would work with the governments and local stakeholders to ensure patients could access it. It’s a great achievement and more importantly represents a major step forward in reducing the burden of cardiovascular illness and death.”
An initial barrier to using NOACs could be the cost.
Although it is deemed cost-effective, all four NOACs medicines - dabigatran, rivaroxaban, apixaban and edoxaban - remain patent protected in several countries and their cost can vary widely.
For example, dabigatran costs USD$65 (£49) per patient per month in the UK and USD$222 (£169) in China.
However these costs need to be set against the costs of monitoring required with VKA treatment and health care systems costs.
Against this backdrop, NOACs are expected to have a lower cost over time and in 2020 the NOAC brand dabigatran loses its patents so a much cheap generic could be produced.
Di Cesare concludes: “Bringing NOACs within reach of those who need it the most, especially in low- and middle-income countries, is the next frontier in ensuring access to anticoagulation therapy, successfully managing heart disease and lowering the risk of stroke.
“We have successfully completed the first step. Further work is now need on several fronts including requiring governments to include NOACs in their national essential medicines list as well as ensuring their provision in health facilities and pharmacies to promote patient access.”
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