Cost-effectiveness of Guided Internet-Delivered Cognitive Behavioral Therapy in Comparison with Care-as-Usual for Patients with Insomnia in General Practice. Issue 2 (4th March 2022)

• Record Type: Journal Article
• Authors: Baka, Agni; van der Zweerde, Tanja; Lancee, Jaap; Bosmans, Judith E.; van Straten, Annemieke
• Is Part Of: Behavioral sleep medicine. Volume 20:Issue 2(2022)
• Page Start: 188
• Page End: 203
• Publication Date: 2022-03-04
• Subjects: Sleep disorders -- Periodicals; Sleep -- Psychological aspects -- Periodicals; 616.8498
• DOI: 10.1080/15402002.2021.1901708
• Languages: English
• ISSNs: 1540-2002

Abstract

ABSTRACT: Study objectives: Clinical guidelines recommend cognitive-behavioral therapy for insomnia (CBT-I) as first-line treatment. However, provision of CBT-I is limited due to insufficient time and expertise. Internet-delivered CBT-I might bridge this gap. This study aimed to estimate the cost-effectiveness of guided, internet-delivered CBT-I (i-Sleep) compared to care-as-usual for insomnia patients in general practice over 26 weeks from a societal perspective. Methods: Primary outcomes were the Insomnia Severity Index (ISI, continuous score and clinically relevant response), and Quality-Adjusted Life Years (QALYs). Societal costs were assessed at baseline, and at 8 and 26 weeks. Missing data were imputed using multiple imputation. Statistical uncertainty around cost and effect differences was estimated using bootstrapping, and presented in cost-effectiveness planes and acceptability curves. Results: The difference in societal costs between i-Sleep and care-as-usual was not statistically significant (-€318; 95% CI −1282 to 645). Cost-effectiveness analyses revealed a 95% probability of i-Sleep being cost-effective compared to care-as-usual at ceiling ratios of €450/extra point of improvement in ISI score and €7, 000/additional response to treatment, respectively. Cost-utility analysis showed a 67% probability of cost-effectiveness for i-Sleep compared to care-as-usual at a ceiling ratio of 20, 000 €/QALY gained. Conclusions: The internet-delivered intervention may be considered cost-effective for insomnia severity in comparison with care-as-usual from the societal perspective. However, the improvement in insomnia severity symptoms did not result in similar improvements in QALYs.