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Press Release
Tablet-splitting Saves VA $46.5 Million on Popular Statin
For Release at 12:30 P.M. CT, Wednesday, November 10, 2004
NEW ORLEANS — A Veterans Affairs (VA) researcher reported on Nov. 10 at the American Heart Association scientific meeting in New Orleans that VA, the nation's largest health system, saved $46.5 million in 2003 by having eligible patients split their tablets of a popular cholesterol-lowering drug, simvastatin, in half.
Tablet-splitting saves money because many drugs are available in higher-dose tablets for the same price as lower-dose tablets. By using the higher-dose tablets and splitting them in half, patients can get their usual dose for about half the cost. This can mean huge savings for health systems that provide pharmacy benefits. The researchers cautioned that patients should spilt their tablets only with the approval of their health care provider.
In addition to reporting VA's system-wide savings for fiscal year 2003, David Parra, PharmD, of the West Palm Beach (Fla.) VA Medical Center, shared findings from a study that tracked 3,787 VA patients in Florida, Puerto Rico and Georgia who were taking simvastatin, commercially sold as Zocor, in 1999. Half the patients were converted from whole to split tablets, maintaining the same daily dose, while the other half continued on their whole tablets. Tablet splitters and instructions were provided to those on the split tablets.
Both groups had the same outcome after 12 months-roughly an eight-point drop in their LDL, or "bad," cholesterol scores, from an average of about 120 to 111. No difference was seen in liver function-a measure of drug toxicity-nor in the percentage of patients who stuck to their prescription.
Based on this and other research, VA doctors and pharmacies have progressively widened the tablet-splitting program. In fiscal 2003, 86 percent of eligible simvastatin prescriptions in VA nationwide were split, resulting in $46.5 million in savings. About 1.3 million of VA patients nationally were on simvastatin, accounting for 84 percent of all statin prescriptions in VA.
Some patients are not eligible for splitting because of certain medical conditions that might limit their ability to use a tablet splitter, such as disabling arthritis or visual impairment.
Tablet-splitting doesn't work with some medications-for example, time-release tablets or those with a special coating. One reason why statins are a good candidate for tablet-splitting is that the dose doesn't have to be as exact as with some other classes of drugs to be effective.
According to Parra, statins are the major drug class in which patients worldwide are skimping-not taking as much of the drug as their doctors recommend-to save money. He says this could lead to increased rates of angina, heart attack and stroke.
The drugs, while hugely popular, are relatively expensive. Parra offered the example of one pharmacy chain that sells 40mg and 80mg tablets of simvastatin for the same price-$147.79 per one-month supply. He said the savings for one patient on 40 mg who splits an 80mg tablet could be $850 per year.
"While this is a significant amount of money, patients should not take it upon themselves to start splitting any medication without first consulting their health care provider," said Parra.
Simvastatin and other statins work by blocking an enzyme that enables natural production of cholesterol in the liver. When the liver is low in cholesterol, this activates a protein known as LDLR (liver low-density lipoprotein receptor). Anchored to the surface of liver cells, LDLR grabs particles of LDL cholesterol from the blood and draws them inside the cell. This lowers bad cholesterol in the bloodstream.
Parra said his region of VA, Veterans Integrated Service Network (VISN) 8, targets 14 medications for splitting, mostly cholesterol-lowering medications and antidepressants. He said this saves VISN 8 about $13 million annually.
Parra's research was supported by VA. Co-authors include Nick Beckey, Harsha Raval, Kimberly Schnacky, Vincent Calabrese, Roy Coakley and Robert Goodhope, all with VISN 8, covering Florida, parts of southern Georgia and Puerto Rico.
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