Create doacs_nhse.json

openprescribing/measures/definitions/doacs_nhse.json

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+{
+  "name": "Proportion of Direct Acting Oral Anticoagulants (DOACs) not prescribed as generic rivaroxaban or generic apixaban tablets",
+  "title": "Percentage DOAC items not prescribed as generic rivaroxaban or generic apixaban tablets",
+  "description": "Percentage DOAC items not prescribed as generic rivaroxaban or generic apixaban tablets",
+  "numerator_short": "DOAC items not prescribed as generic rivaroxaban or generic apixaban tablets",
+  "denominator_short": "DOAC items",
+  "y_label": "Percentage DOACs not prescribed as generic rivaroxaban or generic apixaban tablets",
+  "why_it_matters": [
+    "In September 2024 the NHS in England released <a href='https://www.england.nhs.uk/long-read/commissioning-recommendations-for-national-procurement-for-doacs/' target='_Blank'>",
+    "updated commissioning regulations for DOACs,</a> which state:</p>",
+    "<p><i>For patients commencing treatment for atrial fibrillation (AF): subject to the criteria specified in the relevant NICE technology appraisal guidance, clinicians should use ",
+    "the best value DOAC that is clinically appropriate for the patient. </p>",
+    "<p>Table 1 provides the available DOACs ranked from highest to lowest best value according to the September 2024 and confidential framework prices.",
+    "If the highest ranked best value DOAC (generic apixaban or generic rivaroxaban) is contraindicated or not clinically appropriate for the specific patient then, subject to the criteria ",
+    "specified in the relevant NICE technology appraisal guidance, clinicians should then consider the next highest ranked DOAC (edoxaban) and so on until an appropriate treatment is identified.",
+    "</i>",
+    "<table style=\"border-collapse: collapse; border-spacing: 10px;\" border=\"1\">",
+    "<thead>",
+    "  <tr>",
+    "    <th style='width: 30%; padding: 10px;'>Overall rank</th>",
+    "    <th style='padding: 10px;'>DOAC</th>",
+    "    <th style='padding: 10px;'>Notes</th>",
+    "  </tr>",
+    "</thead>",
+    "<tbody>",
+    "  <tr>",
+    "    ",
+    "    <td style='padding: 10px;'><b>1 (Joint best value)</b></td>",
+    "    <td style='padding: 10px;'><b>Rivaroxaban (generic)<br>Apixaban (generic)</td>",
+    "    <td style='padding: 10px;'><b>Best value once a day treatment<br>Best value twice a day treatment</b></td>",
+    "  </tr>",
+    "  <tr>",
+    "    <td style='padding: 10px;'>2</td>",
+    "    <td style='padding: 10px;'>Edoxaban (Lixiana<sup>®</sup>)</td>",
+    "    <td style='padding: 10px;'></td>",
+    "  </tr>",
+    "  <tr>",
+    "    <td style='padding: 10px;'>3</td>",
+    "    <td style='padding: 10px;'>Xarelto<sup>®</sup> (branded rivaroxaban)</td>",
+    "    <td style='padding: 10px;'> </td>",
+    "  </tr>",
+    "  <tr>",
+    "    <td style='padding: 10px;'>4</td>",
+    "    <td style='padding: 10px;'>Dabigatran (Pradaxa<sup>®</sup>)</td>",
+    "    <td style='padding: 10px;'> </td>",
+    "  </tr>",
+    "  <tr>",
+    "    <td style='padding: 10px;'>5</td>",
+    "    <td style='padding: 10px;'>Eliquis<sup>®</sup> (branded apixaban)</td>",
+    "    <td style='padding: 10px;'> </td>",
+    "  </tr>",
+    "</tbody>",
+    "</table>",
+    "</ul>",
+    "</p>",
+    "<p>The <a href='https://www.england.nhs.uk/long-read/national-medicines-optimisation-opportunities-2023-24/#9-identifying-patients-with-atrial-fibrillation-and-using-best-value-direct-acting-oral-anticoagulants' target='_Blank'>",
+    "NHS England National Medicines Optimisation Opportunities for 2024/25</a> also identify using best value direct-acting oral anticoagulants as an area for improvement.</p>",
+    "<p><b>Please note:</b> OpenPrescribing.net measures have a consistent way of visualising measures, where 'lower is better' ",
+    "and therefore in this case we show the proportion of DOACs which are NOT prescribed as edoxaban or generic apixaban tablets.  There are also other oral formulations of generic DOACs recently introduced onto the market.",
+    "We do not consider these to be as cost-effective, and they are not considered as first-line in this measure." 
+  ],
+  "tags": [
+    "cardiovascular",
+    "core",
+    "cost",
+    "opportunities"
+  ],
+  "url": null,
+  "is_percentage": true,
+  "is_cost_based": false,
+  "low_is_good": true,
+  "numerator_type": "custom",
+  "numerator_columns": "SUM(p.items) AS numerator",
+  "numerator_from": [
+    "{hscic}.normalised_prescribing p ",
+    "INNER JOIN {dmd}.vmp vmp ON CONCAT(SUBSTR(p.bnf_code,0,9),'AA', SUBSTR(p.bnf_code,-2), SUBSTR(p.bnf_code,-2)) = vmp.bnf_code -- joins prescribing data to vmp table using generic BNF code \n",
+    "INNER JOIN {dmd}.vpi AS vpi ON vmp.id = vpi.vmp -- joins vmp to vpi table to get ingredient strengths (strnt_nmrtr_val) \n",
+    "INNER JOIN {dmd}.ont AS ont ON vmp.id = ont.vmp -- joins vmp to ont table to get formulation codes \n",
+    "INNER JOIN {dmd}.ontformroute AS route ON ont.form = route.cd -- joins ont table to ontform table to get formulation names "
+  ],
+  "numerator_where": [
+    "vpi.ing = 698090000 AND NOT((SUBSTR(p.bnf_code,10,2) ='AA' AND route.descr ='tablet.oral')) --Apixaban (except generic tablets) \n",
+    "OR vpi.ing = 700039002 --Dabigatran etexilate mesilate \n",
+    "OR vpi.ing = 1162278009 --Edoxaban tosilate\n", 
+    "OR vpi.ing = 442031002 AND NOT((SUBSTR(p.bnf_code,10,2) ='AA' AND route.descr ='tablet.oral')) --Rivaroxaban (except generic tablets) "
+  ],
+  "denominator_type": "custom",
+  "denominator_columns": "SUM(p.items) AS denominator",
+  "denominator_from": [
+    "{hscic}.normalised_prescribing p ",
+    "INNER JOIN {dmd}.vmp vmp ON CONCAT(SUBSTR(p.bnf_code,0,9),'AA', SUBSTR(p.bnf_code,-2), SUBSTR(p.bnf_code,-2)) = vmp.bnf_code -- joins prescribing data to vmp table using generic BNF code \n",
+    "INNER JOIN {dmd}.vpi AS vpi ON vmp.id = vpi.vmp -- joins vmp to vpi table to get ingredient strengths (strnt_nmrtr_val) \n"
+  ],
+  "denominator_where": [
+    "vpi.ing IN (698090000,1162278009,700039002,442031002) --Apixaban, dabigatran etexilate mesilate, edoxaban tosilate, rivaroxaban \n"
+  ], 
+"authored_by": "[email protected]",
+  "checked_by": "[email protected]",
+  "date_reviewed": "2024-10-01",
+  "next_review": "2026-09-16",
+  "measure_complexity": "low",
+  "measure_type": "dmd",
+  "radar_exclude": false
+}