The practice of splitting tablets: cost and therapeutic aspects.

BACKGROUND: Tablet splitting is used in pharmacy practice to adjust the dose to be administered. It is also being advocated as a method of reducing prescription drug costs.
METHODS: The potential for using this practice as a cost-saving method was examined. The top 200 prescription products in Canada were evaluated for their potential for tablet splitting to reduce costs. The assessment was based on the dosage form (only tablets could be split), availability of dosages in multiples, whether the drug was used for long-term therapy, whether the product was packaged suitably (e.g. oral contraceptives in a therapeutic package), whether pricing structure would allow substantial saving, and the physical nature of the tablets (e.g. whether there were special dose-release characteristics). The products most commonly split in three Canadian pharmacies were compared with the products that had a substantial savings potential. Costs for splitting tablets in the pharmacy and costs of instructing patients to split tablets were calculated.
RESULTS: Savings could be generated from tablet splitting for only 15 of the 200 products. There was little overlap between these 15 products and the products that were most frequently split in the three pharmacies. The costs associated with tablet splitting in the pharmacy were approximately 0.1 Canadian dollars ($Can) per tablet. The cost of instructing a patient to split the tablets was approximately $Can1.
CONCLUSIONS: Tablet splitting appears to have limited usefulness as a cost-reduction strategy. Only a small proportion of products are suitable for splitting and have the potential for savings. There are also costs arising from splitting tablets in the pharmacy, or instructing patients to do so, and from wastage of product. There are also issues such as patient compliance and the risk of an incorrect dose being taken that should be considered.