Pill-Splitting Safe, Will Save Money, Study Finds
The practice of pill-splitting can reduce prescription drug costs without "risking the effectiveness" of the treatments or patient safety, according to a new study, the Wall Street Journal reports. The study, published in the current issue of the American Journal of Managed Care, is "one of few" to examine the issue of patient safety and to establish guidelines to determine "which pills are best suited to cutting." Pill-splitting reduces prescription drug costs because drug companies charge the same amount for pills "regardless of the dose," the Journal reports. In the study, researchers at the Stanford University Center for Research in Disease Prevention examined a list of 256 treatments "commonly prescribed" at a small Boston-based health plan over a nine-month period in 2000. The study found that 48 of the treatments "could be split," but "only 11 were prescribed often enough to be found both clinically appropriate and cost effective" to split. The list of 11 includes the anti-cholesterol treatment Lipitor and the impotency medication Viagra, manufactured by Pfizer; the anti-depressants Paxil from GlaxoSmithKline and Celexia from Forest Laboratories; and the ACE inhibitor lisinopril, marketed as Prinvil by Merck and Zestril by AstraZeneca.
Many Treatments Not 'Suitable'
The list of treatments that researchers found "suitable for splitting" included pills "particularly easy to break in half," such as those scored with a line down the middle. Researchers eliminated 125 treatments available only in one dose, available only in capsule form, available only in prepackaged form or not available in pill form. In addition, researchers eliminated 31 treatments that have time-release formulations or could have "adverse consequences if dosage varied to any significant extent," the Journal reports. Dr. Randall Stafford, the study's lead author, said that pill-splitting "can provide cost savings without really changing the clinical care patients are getting." However, he added, "You need to make sure it's done accurately, with full discussion between patients and physicians." Marjorie Powell, assistant general counsel for the Pharmaceutical Research and Manufacturers of America, said, "It clearly isn't consistent with FDA labeling because you don't know exactly what dose the patient is getting" (Winslow, Wall Street Journal, 8/30).
NPR's "All Things Considered" on Aug. 30 included an interview with Stafford about the practice of pill-splitting (Siegel, "All Things Considered," NPR, 8/30). The full segment is available in RealPlayer Audio online.
