The amount spent on prescriptions for atrial fibrillation conditions has increased by 129.6% since 2016
The NHS spend on drugs used to treat some cardiovascular illnesses has risen by nearly half a billion pounds since 2016.
The increase follows an update in the National Institute for Clinical Excellence for Atrial Fibrillation Diagnosis and Management (NICE AF) in 2014 which recommended healthcare workers use a wider range of novel oral anticoagulants to treat heart disease.
Data from the British National Formulary, which offers information and advice on medical prescriptions and treatments, and analysed by the Byline Intelligence Team, has revealed that the spend on anticoagulants and protamine treatments for cardiovascular disease increased to more than £742 million in 2020 from £299 million in 2016 – or by 129.6%.
Already, the 2016 figures represented an increase from £84 million in 2014, when the NICE AF guidelines were updated.
Pre-2014, the NICE AF guidance encouraged doctors to prescribe warfarin for atrial fibrillation conditions. The guidance then switched to recommending healthcare professionals use alternatives to warfarin when treating cardiovascular disorders. NICE AF pointed to a range of novel oral anticoagulants (NOACs) such as apixaban, dabigatran etexilate and rivaroxaban as suitable options.
Patients experiencing cardiovascular issues who take warfarin require regular monitoring, which can of course put pressure on primary care services. In contrast, the NOACs recommended in the updated NICE guidance do not require patients to have regular monitoring. It was also suggested that the updated list of drugs could be a better option for patients who struggled with dosage control.
The increase in spending on prescriptions for medicines treating cardiovascular disease is, in part, down to greater awareness of protecting patients living with atrial fibrillation. However, the NOACs listed in the guidance can cost up to three times the amount of warfarin, which also accounts for the rise in spend.
Since the switch, the pharmaceutical companies manufacturing the new drugs have seen a significant uptick in their profits. Bayer, one of the main producers of rivaroxaban, declared a loss of £54 million in 2016. However, by 2019 its fortunes had turned around, with a profit of £60 million. In 2020 it declared a profit of £33 million.
Deaths from heart disease have decreased significantly in the past decade, although they still cause a quarter of all deaths in the UK.
At the start of the century, heart disease accounted for 503 deaths in every 100,000. By 2014, when the NICE AF guidance changed, it had nearly halved to 263 per 100,000. Since the guidance changed, death rates have remained relatively static: in 2020 heart disease made up 259 of every 100,000 deaths.
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Although anticoagulant and protamine prescriptions saw the biggest price rises, other drug treatments have also seen above-inflation cost rises since 2016 – including treatments for hypertension and heart failure, which had risen by 39.59%.
Antisecretory drug and mucosal protectants used to treat the gastro-intestinal system have increased in cost by 39.07% since 2016 to £180 million in 2020. Antisecretory drugs treat gastroesophageal reflux disease, which affects around five in 1,000 people in the UK. The costs of drugs used to treat diabetes increased by 12.09% between 2016 and 2020 – again, an above inflation rise.
The largest drop in NHS spending on prescriptions was for epilepsy, which went down by 46.54% between 2016-20, despite the number of people with a known diagnosis increasing over the past 14 years. 402,000 people with a known diagnosis of epilepsy in the UK in 2008/09, today it is over 600,000. Death rates have remained fairly stable: in 2014, 747 people died from causes related to epilepsy – a number that dropped to 743 in 2019.
Pressures on Prescription Budgets
Already in 2016, alarm bells were ringing that the rising spend on atrial fibrillation treatment was putting pressure on GP budgets.
GP Online reported how the move to prescribe NOACs as the first choice for patients diagnosed in hospitals was putting pressure on GPs’ prescribing budgets once the patient moved back into primary care.
Each GP practice is set a prescription budget by the clinical commissioning group (CCG) it sits under. CCGs are set to be replaced by new integrated care boards (ICBs), following the passing of the Health and Social Care Act last month. These boards will take over all commissioning responsibilities from the CCGs, including setting GP budgets.
ICBs have faced criticism from NHS campaigners who have expressed concern that representatives from private healthcare interests can be invited to join the board and influence commissioning and budget decisions.
The Byline Intelligence Team’s analysis comes at a time when GP surgeries and primary care services are already feeling the pressure when it comes to budgets.
A £550 million cut to councils' public health grants between 2015/16 and 2019/20 left local authorities and GP practices struggling to meet demand and in 2019 it was reported that GP services were facing large funding deficits due to real-term cuts to NHS spending since 2010.
In 2020, the British Medical Association raised how GP services had endured a decade of under-investment and called for 11% of the NHS budget to be allocated to GPs – an additional £3.6 billion. In 2017, GPs received 8.1% of the NHS budget, excluding the reimbursement of drugs. This was a decrease from in 2005/06, when they received 9.6%. The Chancellor failed to pledge additional funding for GP services in his 2022 Spring Budget.
Additional reporting by Iain Overton
This article was produced by the Byline Intelligence Team – a collaborative investigative project formed by Byline Times with The Citizens. If you would like to find out more about the Intelligence Team and how to fund its work, click on the button below.
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