Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation
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In: Sleep, Vol. 39, No. 10, 01.10.2016, p. 1769-1778.
Research output: Journal contributions › Journal articles › Research › peer-review
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TY - JOUR
T1 - Internet-Based Cognitive Behavioral Therapy for Insomnia
T2 - A Health Economic Evaluation
AU - Thiart, Hanne
AU - Ebert, David Daniel
AU - Lehr, Dirk
AU - Nobis, Stephanie
AU - Buntrock, Claudia
AU - Berking, Matthias
AU - Smit, Filip
AU - Riper, Heleen
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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 costeffectiveness 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.
AB - 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 costeffectiveness 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.
KW - Psychology
KW - cost-benefit
KW - cost-effectiveness
KW - employer perspective
KW - insomnia
KW - randomized controlled trial
KW - self-help
KW - Internet
KW - Business psychology
KW - Digital media
UR - http://www.scopus.com/inward/record.url?scp=84992390436&partnerID=8YFLogxK
U2 - 10.5665/sleep.6152
DO - 10.5665/sleep.6152
M3 - Journal articles
C2 - 27450686
VL - 39
SP - 1769
EP - 1778
JO - Sleep
JF - Sleep
SN - 0161-8105
IS - 10
ER -