Impact of patient financial incentives on participation and outcomes in a statin pill-splitting program

Choe HM, Stevenson JG, Streetman DS, Heisler M, Sandiford CJ, Piette JD. Impact of patient financial incentives on participation and outcomes in a statin pill-splitting program. The American journal of managed care. 2007 Jun 1; 13(6 Part 1):298-304.

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Abstract:

OBJECTIVES: To examine willingness to participate in a pill-splitting program and the impact of pill splitting on patients' adherence and lipid control. STUDY DESIGN: Nested randomized trial. METHODS: A total of 200 patients who used statins and were candidates for a pill-splitting regimen were identified from a large university-based health plan. Sixty-three percent of study participants were female, 41% were nonwhite, and 94% had at least some college education. Patients were surveyed regarding their willingness to split pills, and 111 consented to participate in a 6-month trial in which half were randomized to receive a financial incentive to split pills: a 50% reduction in their per-refill copayment. Data on patients' statin refills and lipid control were obtained from billing and medical records. RESULTS: Compared with patients unwilling to participate in the program, those agreeing to split pills were more likely to be female and white. After 6 months, most patients in the trial (89%) were willing to continue pill splitting for a 50% copayment reduction. Patients reported few problems with pill splitting and had no noticeable change in their adherence. The financial-incentive group and the control group did not differ significantly with respect to their low-density lipoprotein cholesterol levels after pill splitting: -2.0 mg/dL and -1.2 mg/dL, respectively. CONCLUSIONS: Most patients indicated that at least a 50% copayment reduction would be required to enroll in a pill-splitting program after the study ended. However, in this relatively educated population, financial incentives did not influence patients' adherence, satisfaction, or health outcomes.