PB2626 Anticoagulation Stewardship: Measuring Best Value Direct Oral Anticoagulant Use in the National Health Service in England using OpenPrescribing Hospitals

Abstract

Background

The concept of anticoagulation stewardship has gained momentum in recent years. It is defined as a coordinated, efficient, and sustainable system-level initiative to optimise anticoagulant-related health outcomes and minimise adverse drug events. The National Health Service (NHS) in England has a rich source of openly available medicines data. Several platforms support analysis of prescribing in primary care, including OpenPrescribing.net. We recently launched the OpenPrescribing Hospitals platform (https://hospitals.openprescribing.net/) to enable similar analyses across all NHS hospitals in England. A key challenge faced by the NHS is to ensure that the most cost-effective medication are prescribed.

Aims

To develop a publicly available measure (pre-built analyses) on the new OpenPrescribing Hospitals platform for best value direct oral anticoagulants (DOACs) issued in the NHS in England in secondary care.

Methods

The OpenPrescribing Hospitals platform uses the Secondary Care Medicines Dataset which comprises stock issuing data from hospital pharmacies in all NHS trusts in England. The platform uses measures to quantify activity for clinical areas of interest based on national medicines recommendations. We developed a measure based on NHS England (NHSE) commissioning recommendations for DOACs, which state that clinicians should use the best value DOAC that is clinically appropriate for the patient. At the time of analysis apixaban and rivaroxaban (prescribed generically) were the best value DOACs (Guidance published September 2024).

In the developed measure, the percentage of all DOACs issued that were not apixaban or rivaroxaban tablets was calculated using Defined Daily Doses (DDDs) each month (2019-2025). Measures were then visualised on an interactive time-series chart. In NHS Trust mode, a percentile chart is displayed, allowing individual trusts to be selected for comparison.

The development of the OpenPrescribing Hospitals software infrastructure was funded with support from NHSE. No ethical approval was required.

Results

The measure shows the proportion of DOACs issued in hospital trusts in England that are not apixaban or rivaroxaban tablets. Individual trusts can be overlaid on the chart to benchmark local prescribing against other trusts. The measure is publicly available at https://hospitals.openprescribing.net/measures/best_value_doacs/.

Conclusion

OpenPrescribing Hospitals can be used to measure national best value DOAC prescribing in hospitals in England. It can be used to identify unwarranted variation and identify areas for local quality improvement. Our work shows that the platform could be used to address other anticoagulation stewardship initiatives.