Cost regulators for the National Health Service in England and Wales are planning to expand the use of Lilly UK's bloodthinner Efient (prasugrel) to help prevent atherothrombotic events in more people.

The National Institute for Health and Care Excellence has published draft guidance now recommending use of the drug in combination with aspirin for preventing blood clots in people who have had a heart attack or who have unstable angina (collectively known as acute coronary syndromes or ACS) and those undergoing a procedure to widen narrowed heart arteries.

Previous guidance published in 2009 largely only approved funding for Efient 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, massively reducing the potential treatment population.

The current review assessed the clinical and cost effectiveness of Efient, noting that since the original guidance was published other guidelines on the use of ticagrelor for the same indication have been developed, and the price of another drug, clopidogrel, has reduced as generic versions have become available. 

"Taking these factors into consideration, the draft guidance now recommends prasugrel as an option for more people with acute coronary syndromes than our previous guidance," noted Carole Longson, director of the Centre for Health Technology Evaluation at NICE.

Efient's official price tag is £47.56 per 28-tab pack (excluding VAT) making an annual cost of £628.48. The drug's incremental cost effectiveness ratio for all of the four subgroups assessed (STEMI with diabetes, STEMI without diabetes, unstable angina or NSTEMI with diabetes, unstable angina and NSTEMI without diabetes) fell under £20,000 per QALY gained, and was thus it was deemed value for money for the NHS.