Educational intervention helps doctors and patients split statin tablets to save money for patients and payers
Research Activities, February 2012, No. 378
Most patients want to save money on their prescriptions, particularly those that are brand name. Because the price per tablet for many medications is the same regardless of the dose, patients can save money by splitting a higher-dose tablet in two, a practice known as "tablet splitting." While not all medications can be split, research has shown that statins used to lower cholesterol, which are often quite expensive, can be split without compromising safety or efficacy. For example, if a patient needs 40 mg per day of a cholesterol medication, the physician can write a prescription for the higher-dose 80 mg tablet. The patient can then split the 80 mg pill in half and get two 40 mg doses from the one tablet, thus cutting costs in half. Physicians don't always think about doing this for their patients or if they do, may worry about the safety implications of tablet splitting.
Using an inexpensive intervention, researchers have found a way to educate general practitioners (GPs) about the safety, efficacy, and cost benefits of statin splitting. A simple statin chart insert significantly increased splitting rates among these physicians. GPs in British Columbia, Canada, received three chart inserts to encourage and educate them about statin splitting and its benefits. Two inserts, meant for the physician only, detailed the average yearly costs of statins and recommended how to write tablet-splitting prescriptions. The third insert, which instructed patients on how to use a tablet splitter, was given to patients to take home. Physicians were also called on the phone to reinforce the intervention. A total of 282 GPs agreed to participate in the intervention. Prior to receiving the three inserts, the rate of splitting statins was 2.6 percent. Following the intervention, however, the rate increased to 7.5 percent and was sustained during a 22-month follow-up period.
Those patients most likely to receive a split-statin prescription had lower incomes or no drug coverage, suggesting that physicians were mindful of their patients' ability to pay for their medications. Women were 26 percent more likely than men to receive these types of prescriptions. In contrast, physicians were less likely to write a tablet-splitting prescription for patients age 80 or older than patients age 55 to 59. Physicians may have perceived that elderly patients were too frail or cognitively impaired to adequately split their statin tablets. The study was supported in part by the Agency for Healthcare Research and Quality (HS10881).
See "Time series evaluation of an intervention to increase statin tablet splitting by general practitioners," by Jennifer M. Polinski, Sc.D., M.P.H., Sebastian Schneeweiss, M.D., Sc.D., Malcolm Maclure, Sc.D., and others in Clinical Therapeutics 33(2), pp. 235-243, 2011.