NICE has concluded that they are likely to be within what NICE considers a cost-effective use of NHS resources for gastrointestinal bleeding, and it recommends andexanet alfa in GI bleeds as defined in the ANNEXA-4 trial and used as part of a major GI bleed protocol. The cost-effectiveness estimates are uncertain due to the limitations in the evidence. However due to differences between these 2 trials, the results are uncertain. This suggests that andexanet alfa improves survival in people with gastrointestinal bleeding or intracerebral haemorrhage (ICH), but lowers survival for people with bleeds in other parts of the body. There is no clinical trial evidence directly comparing andexanet alfa with prothrombin complex concentrate, so an indirect comparison of 2 trials was conducted. In June 2020 the committee discussed a number of issues, some of which had not been included in the first appraisal consultation document. In the first appraisal consultation document, issued in March 2020, NICE did not recommend andexanet alfa within its marketing authorisation.

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