Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation
- PMID: 27450686
- PMCID: PMC5020359
- DOI: 10.5665/sleep.6152
Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation
Abstract
Study objectives: Lost productivity caused by insomnia is a common and costly problem for employers. Although evidence for the efficacy of Internet-based cognitive behavioral therapy for insomnia (iCBT-I) already exists, little is known about its economic effects. This study aims to evaluate the cost-effectiveness and cost-benefit of providing iCBT-I to symptomatic employees from the employer's perspective.
Methods: School teachers (N = 128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a waitlist-control-group, both with access to treatment as usual. Economic data were collected at baseline and 6-mo follow-up. We conducted (1) a cost-effectiveness analysis with treatment response (Reliable Change [decline of 5.01 points] and Insomnia Severity Index < 8 at 6-month follow-up) as the outcome and (2) a cost-benefit analysis. Because both analyses were performed from the employer's perspective, we focused specifically on absenteeism and presenteeism costs. Statistical uncertainty was estimated using bootstrapping.
Results: Assuming intervention costs of €200 ($245), cost-effectiveness analyses showed that at a willingness-to-pay of €0 for each positive treatment response, there is an 87% probability that the intervention is more cost effective than treatment as usual alone. Cost-benefit analyses led to a net benefit of €418 (95% confidence interval: -593.03 to 1,488.70) ($512) per participant and a return on investment of 208% (95% confidence interval: -296.52 to 744.35). The reduction in costs was mainly driven by the effects of the intervention on presenteeism and to a lesser degree by reduced absenteeism.
Conclusions: Focusing on sleep improvement using iCBT-I may be a cost-effective strategy in occupational health care.
Clinical trials registration: Title: Online Recovery Training for Better Sleep in Teachers with High Psychological Strain. German Clinical Trial Register (DRKS), URL: https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004700. Identifier: DRKS00004700.
Commentary: A commentary on this article appears in this issue on page 1767.
Keywords: Internet; cost-benefit; cost-effectiveness; employer perspective; insomnia; randomized controlled trial; self-help.
© 2016 Associated Professional Sleep Societies, LLC.
Figures
Comment in
-
Value-Based Sleep in the Workplace.Sleep. 2016 Oct 1;39(10):1767-1768. doi: 10.5665/sleep.6150. Sleep. 2016. PMID: 27634808 Free PMC article. No abstract available.
References
-
- Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry. 1994;151:1172–80. - PubMed
-
- Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med. 2015;163:191–204. - PubMed
-
- Geiger-Brown JM, Rogers VE, Liu W, Ludeman EM, Downton KD, Diaz-Abad M. Cognitive behavioral therapy in persons with comorbid insomnia: a meta-analysis. Sleep Med Rev. 2014;23C:54–67. - PubMed
-
- Botteman M. Health economics of insomnia therapy: implications for policy. Sleep Med. 2009;10:22–5. - PubMed
-
- Wickwire EM, Shaya FT, Scharf SM. Health economics of insomnia treatments: the return on investment for a good night's sleep. Sleep Med Rev. 2016;30:72–82. - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials
Miscellaneous