Presentation (CTI)

OBJECTIVES: DOACs are effective in preventing stroke in patients with atrial fibrillation (AF) and have been widely adopted across the NHS in England. NHS England commissioning policy suggests that usage of the lowest-cost acquisition DOAC should be increased, including through reviewing patient medication plans through a combination of opportunistic and systematic medication reviews. The purpose of this study was to identify and validate assumptions for inputs into a health economic model which quantifies the operational and NHS resource costs associated with intra-DOAC switching, and to develop a generic switching pathway model applicable across Integrated Care Boards (ICBs) in England.
METHODS: A structured desk-based research approach was employed, including an OVID literature search and a targeted Google search to identify publicly available NHS guidelines and standard operating procedures (SOPs) relating to intra-DOAC switching in patients with atrial fibrillation (AF). The review focused on consistent operational steps, healthcare professional involvement, and time commitments. Time commitments for proportional steps and batch processing feasibility were estimated based on assumptions. Expert involvement was facilitated through a series of interviews to validate research results.
RESULTS: Whilst the peer-reviewed literature on this topic was limited, several ICB-level SOPs were identified. These documents revealed variability in implementation but shared common operational touchpoints. A generic switching schematic was developed, outlining 11 key steps involving pharmacists, General Practitioners, pharmacy technicians, and nurses. Estimated average time per patient was approximately 69 minutes, distributed across pharmacist-led reviews, GP consultations, technical processing, and patient communication steps.
CONCLUSIONS: The developed switch pathway provides a structured framework for integrating operational costs into a health economic evaluation that can assist in health system resource decision-making in this field. This enables more comprehensive assessments of the opportunity costs and trade-offs associated with DOAC switching policies and may inform decision-making at both the ICB and national levels in the NHS.