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  "documentTitle": "Accelerated Access Review UK Mapping",
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      "text": "Challenges: Alignment across key stakeholders, Culture, Budget Siloes, Lack of accountability, Lack of outcome transparency",
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      "text": "Background: Non-Vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, rivaroxaban and apixaban were approved by NICE in 2014 as options for stroke prevention. They were recommended as first-line therapy over traditional treatments (e.g., warfarin & aspirin) and demonstrated improvements in both clinical efficacy and cardiac risk management. NOACs costs are significantly higher than traditional treatments. However NICE has concluded that the drugs are cost-effective and must be available to patients for on-label use. The EHRA, NICE and European Society of Cardiology have all issued separated guidelines recommending NOACs.",
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      "text": "Issues: Despite the NICE recommendation, adoption has been limited. Clinicians believe in the superior safety of aspirin which was communicated in NICE 2006 guideline while some remain unaware of the development of novel medicines in the recent years. Moreover, primary care practitioners often do not want to take responsibility for the first prescription of a NOAC, preferring instead to refer patients to secondary care anticoagulant clinics, which increases system costs. Data from Quality and Outcomes Framework, which details GP practice performance, indicates that only 65% of eligible patients in England received NOACs between 2012 – 2013",
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      "text": "Note: EHRA = European Heart Rhythm Association. Source: NICE, EHRA, European Society of Cardiology, Deloitte interviews",
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