Heart attack patients in England are a step closer to getting routine access to Bayer’s Xarelto (rivaroxaban) on the National Health Service in England after cost regulators issued a provisional green light for preventing blood clots.

The National Institute for Health and Care Excellence has this morning published draft proposals endorsing the drug’s use as an option for preventing blood clots in those who have had a heart attack because of a blockage or narrowing in one of the blood vessels in the heart. 

In this setting, Xarelto’s license covers adults who have an acute coronary syndrome (ACS) severe enough to result in the release of cardiac biomarkers into the blood that show heart muscle has been damaged. In unstable angina, damage to the heart is not severe enough to result in the release of biomarkers into the blood so this condition is not considered in the draft guidance, NICE said.

Clinically and cost effective

Based on the evidence available, the Institute’s independent Appraisal Committee concluded that adding the drug to aspirin plus clopidogrel or aspirin alone is more effective for preventing further cardiovascular deaths and heart attacks in people with ACS and raised cardiac biomarkers. 

At a cost of around £2.10 a day, the Expert Review Group calculated the cost per QALY to be £5,622, and so well within the bounds of what is normally considered a cost-effective use of resources.

On a note of caution, because of a higher risk of bleeding with Xarelto the draft guidance recommends clinicians should undertake a “careful assessment” of a person’s bleeding risk before starting treatment.