Frequency and predictors of tablet splitting in statin prescriptions: a population-based analysis.
Notice bibliographique
Résumé
BACKGROUND: The price per milligram for most statin medications decreases at higher strengths, which provides an economic incentive to split tablets. We sought to determine the frequency with which statin tablets are split, and to evaluate factors associated with this practice. METHODS: We obtained prescription claims data for statins from the BC Ministry of Health for the period Jan. 1, 1996, to Dec. 31, 2006. We estimated the number of tablets per day, based on the ratio of the number of tablets to days-supply in each prescription, to estimate the frequency with which splitting occurred with each statin. We used multivariable logistic regression to assess patient and physician characteristics and the level of public drug plan coverage associated with tablet splitting. To estimate related cost savings, we used information on drug costs and quantities of dispensed statins reported by pharmacies. RESULTS: During the 11-year study period, we estimated that tablet splitting occurred in 2.6% of 7.2 million statin prescriptions. There was an increasing trend in the practice over time, to 4.5% of prescriptions in 2006. Lovastatin was the only scored tablet and was the most likely to be split, followed by rosuvastatin and atorvastatin. Fifty percent of the prescriptions in which tablet splitting occurred were prescribed by only 7.9% of the routine statin prescribers (i.e., > 10 statin prescriptions over the study period). Specialists were less likely than general practitioners to prescribe statins that were subsequently split (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.40-0.46). Statin prescriptions that were fully covered by the public drug plan were half as likely as those with no such coverage to involve tablet splitting (OR 0.48, 95% CI 0.44-0.92). Having no public drug coverage, having a low annual household income and being female were patient factors found to be positively associated with tablet splitting. In 2006, the cost savings associated with tablet splitting was $2.3 million. INTERPRETATION: The frequency of tablet splitting in statin prescriptions in British Columbia was low but increased over time. It varied between patients, physicians and different levels of insurance coverage. In the final study year, 94.5% of the statin prescriptions were dispensed at strengths for which a tablet of twice the strength was available and could have been split, which suggests a potentially enormous cost savings.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».