Statin pill-splitting has no significant effect on adherence or lipid outcomes, regardless of financial incentive

Key Points

Splitting statin tablets does not negatively affect patient satisfaction, medication adherence, or lipid level control, according to the authors of a randomized, controlled study published in the American Journal of Managed Care. The study demonstrated that the outcomes were positive regardless of whether financial incentives for pill-splitting were offered.

In this study, investigators first surveyed 200 potentially eligible patients from a single university-based healthcare plan who were being treated with a statin to determine their willingness to participate in a statin pill-splitting program. A total of 111 participants consented to the 6-month trial that required patients to split their statin tablets in half. Patients were then randomly assigned to receive (n=55) or not to receive (n=56) a 50% reduction in their per-refill copayment as a financial incentive.

At the end of the 6-month program period, nearly 92.7% and 85.2% of participants in the financial incentive and no incentive groups, respectively, stated they would be willing to continue splitting their pills in exchange for a 50% copayment reduction; all but 1.9% and 3.8%, respectively, agreed that pill-splitting was worthwhile as long as they received a copayment reduction.

The most commonly reported concerns with pill-splitting reported by study participants included difficulty using the pill splitter effectively to obtain uncrushed and evenly split tablets and difficulty swallowing split pills due to rough edges or poor taste. Despite these concerns, >90% of participants reported that pill-splitting did not affect their adherence to medication, and mean medication possession ratios were similar in the 6 months before and the 6 months after the start of the pill-splitting program (mean, 94%±17% and mean, 94%±14%). Moreover, at the end of the follow-up period, there were no significant differences between the 2 groups with respect to any evaluated lipid end point (total cholesterol, low-or high-density lipoprotein cholesterol, or triglycerides) when comparing baseline and postprogram levels (P>.24 for all comparisons).

The authors acknowledged some potential limitations to their study such as the exclusion of income data. "[Some] patients may have had relatively high incomes and they may have been less sensitive to the small cost savings associated with pill splitting," they stated.

According to the authors, "In conjunction with other studies, this result suggests that patients receiving Medicaid or other financially pressed pharmacy insurance programs may be more willing to split pills if the program effectively addresses patients' concerns about using the splitter."

SOURCE

Choe HM, Stevenson JG, Streetman DS, Heisler M, Standiford CJ, Piette JD. Impact of patient financial incentives on participation and outcomes in a statin pill-splitting program. Am J Manag Care. 2007;13(part 1):298–304.