The National Institute for Health and Care Excellence is expanding the use of Eli Lilly/Daiichi Sankyo's bloodthinner Efient to help prevent atherothrombotic events in a greater number of people living in England and Wales.

The Institute has published guidance endorsing the drug's use, alongside aspirin, to prevent blood clots in patients who have had a heart attack or who have unstable angina (collectively known as acute coronary syndromes or ACS) or are undergoing percutaneous coronary intervention (PCI).

Previous guidance published in 2009 largely only approved funding for Efient (prasugrel) in patients with ACS undergoing angioplasty, but only when the procedure is necessary due to a certain type of heart attack known as ST-segment-elevation myocardial infarction (STEMI), massively reducing the potential treatment population.

The extended guidance means that both STEMI and NSTEMI patients can now benefit from the treatment, said Jean-Michel Cosséry, managing director of Lilly UK and Northern Europe, and he welcomed the recognition from NICE that Efient is "a cost effective option when compared to generic clopidogrel".

The incremental cost effectiveness ratios for all four subgroups (STEMI with diabetes, STEMI without diabetes, unstable angina or NSTEMI with diabetes, unstable angina and NSTEMI without diabetes) were lower than £20,000 per QALY gained, NICE said.

There are an estimated 32,000 hospital admissions for unstable angina and around 82,000 cases of myocardial infarction in the UK every year.

Amitiza for constipation

Elsewhere, NICE has also issued guidance recommending the use of Sucampo's Amitiza (lubiprostone) on the NHS for treating chronic idiopathic constipation in adults.

The Institute has stipulated that Amitiza, which works by increasing the sliminess of the bowel lining, only be considered for adults who have tried at least two laxatives at the highest tolerated recommended doses for at least six months, but who have not seen an improvement in their symptoms.

The drug costs £53.48 for a 56 capsule pack and £29.68 for a 28 capsule pack.