Effects of a tablet-splitting program in patients taking HMG-CoA reductase inhibitors: analysis of clinical effects, patient satisfaction, compliance, and cost avoidance.

OBJECTIVE The primary objective was to determine the effect of a hydroxymethylglutaryl- CoA reductase inhibitor (HMG) tablet-splitting program on laboratory outcomes (lipid panel and liver enzyme tests). Other objectives were to assess patient compliance and satisfaction with splitting tablets and to measure the reduction in drug acquisition costs. METHODS Patients at a Veterans Affairs Health Care System facility were included in this study if they participated in the HMG tablet-splitting program between April and September 2000. Patients taking the same drug and dosage before and after implementation of the program were asked to complete a mailed questionnaire designed to measure satisfaction and compliance with the program. Data collected through electronic charts included patient demographics, prescribed medication, and the values for lipid panel and liver function tests. RESULTS A total of 2,019 patients were included in the study. The total cost avoidance achieved over one year for atorvastatin, lovastatin, and simvastatin was 138,108 dollars (N=2,019). The majority of patients who responded to the questionnaire were satisfied and compliant with tablet splitting. In the laboratory analysis (N=512), there was no difference between prevalues and postvalues for total cholesterol and triglycerides. There was a statistically, but not clinically, significant decrease in LDL (102 versus 97, P<0.001) and increase in HDL (46 versus 48, P<0.001), AST (26 versus 28, P<0.001), and ALT (24 versus 26, P=0.006) after the initiation of tablet splitting. CONCLUSION Tablet splitting of HMGs had no short-term negative effects on laboratory outcomes and favorable effects on humanistic outcomes as measured by patient satisfaction and compliance. Tablet splitting of HMGs is an effective way to reduce costs and nearly double the number of patients who can be treated for the same expense.