TY - JOUR

T1 - Guided internet-based cognitive behavioral therapy for insomnia

T2 - Health-economic evaluation from the societal and public health care perspective alongside a randomized controlled trial

AU - Buntrock, Claudia

AU - Lehr, Dirk

AU - Smit, Filip

AU - Horvath, Hanne

AU - Berking, Matthias

AU - Spiegelhalder, Kai

AU - Riper, Heleen

AU - Ebert, David Daniel

N1 - This was not an industry-supported study. The European Union funded this study (European Regional Development Fund: ZW6-80119999 and CCI 2007DE161PR001). The funder did not have a role in study design; data collection, analysis, and interpretation of results; or the decision to publish the study results. ©Claudia Buntrock, Dirk Lehr, Filip Smit, Hanne Horvath, Matthias Berking, Kai Spiegelhalder, Heleen Riper, David Daniel Ebert. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 24.05.2021.

PY - 2021/5/24

Y1 - 2021/5/24

N2 - BACKGROUND: The evidence base for internet-based cognitive behavioral therapy for insomnia (iCBT-I) is firm; however, little is known about iCBT-I's health-economic effects.OBJECTIVE: This study aimed to evaluate the cost-effectiveness and cost-utility of iCBT-I in reducing insomnia among schoolteachers.METHODS: Schoolteachers (N=128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a wait list control group, both with unrestricted access to treatment as usual. Health care use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and a public health care perspective. Costs were related to symptom-free status (score <8 on the insomnia severity index) and quality-adjusted life years (QALYs) gained. Sampling error was handled using nonparametric bootstrapping.RESULTS: Statistically significant differences favoring the intervention group were found for both health outcomes (symptom-free status yes or no: β=.30; 95% CI 0.16-0.43; QALYs: β=.019, 95% CI 0.01-0.03). From a societal perspective, iCBT-I had a 94% probability of dominating the wait list control for both health outcomes. From a public health care perspective, iCBT-I was more effective but also more expensive than the wait list control, resulting in an incremental cost-effectiveness ratio of €650 per symptom-free individual. In terms of QALYs, the incremental cost-effectiveness ratio was €11,285. At a willingness-to-pay threshold of €20,000 per QALY gained, the intervention's probability of being cost-effective was 89%.CONCLUSIONS: Our trial indicates that iCBT could be considered as a good value-for-money intervention for insomnia.TRIAL REGISTRATION: German Clinical Trial Registry: DRKS00004700; https://tinyurl.com/2nnk57jm.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1745-6215-14-169.

AB - BACKGROUND: The evidence base for internet-based cognitive behavioral therapy for insomnia (iCBT-I) is firm; however, little is known about iCBT-I's health-economic effects.OBJECTIVE: This study aimed to evaluate the cost-effectiveness and cost-utility of iCBT-I in reducing insomnia among schoolteachers.METHODS: Schoolteachers (N=128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a wait list control group, both with unrestricted access to treatment as usual. Health care use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and a public health care perspective. Costs were related to symptom-free status (score <8 on the insomnia severity index) and quality-adjusted life years (QALYs) gained. Sampling error was handled using nonparametric bootstrapping.RESULTS: Statistically significant differences favoring the intervention group were found for both health outcomes (symptom-free status yes or no: β=.30; 95% CI 0.16-0.43; QALYs: β=.019, 95% CI 0.01-0.03). From a societal perspective, iCBT-I had a 94% probability of dominating the wait list control for both health outcomes. From a public health care perspective, iCBT-I was more effective but also more expensive than the wait list control, resulting in an incremental cost-effectiveness ratio of €650 per symptom-free individual. In terms of QALYs, the incremental cost-effectiveness ratio was €11,285. At a willingness-to-pay threshold of €20,000 per QALY gained, the intervention's probability of being cost-effective was 89%.CONCLUSIONS: Our trial indicates that iCBT could be considered as a good value-for-money intervention for insomnia.TRIAL REGISTRATION: German Clinical Trial Registry: DRKS00004700; https://tinyurl.com/2nnk57jm.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1745-6215-14-169.

KW - Behavior

KW - Cognitive behavioral therapy

KW - Cost-effectiveness

KW - Cost-utility

KW - Economic evaluation

KW - Economics

KW - ICBT-I

KW - Insomnia

KW - Internet-based cognitive behavioural therapy

KW - Perspective

KW - Public health

KW - Sleep

KW - Psychology

KW - Health sciences

UR - http://www.scopus.com/inward/record.url?scp=85106860525&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/ab5ec0e4-3506-3b91-bd97-81b078a4a869/

U2 - 10.2196/25609

DO - 10.2196/25609

M3 - Journal articles

C2 - 34028361

AN - SCOPUS:85106860525

VL - 23

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

SN - 1439-4456

IS - 5

M1 - e25609

ER -