Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 9, 2020
Date Accepted: Apr 17, 2021
Guided internet-based CBT for insomnia: A health-economic evaluation from the societal and public health care perspective alongside a randomized controlled trial
ABSTRACT
Background:
The evidence base for Internet-based cognitive behavioural 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 to reduce insomnia among employees.
Methods:
Schoolteachers (N = 128) with clinically significant insomnia symptoms and work-related rumination were randomised to guided iCBT-I or a waitlist control group (WLC), both with unrestricted access to treatment-as-usual. Healthcare 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 (SFS; score < 8 on the insomnia severity index) and quality-adjusted life years (QALYs) gained. Sample error was handled using non-parametric bootstrapping.
Results:
Statistically significant differences favouring the intervention group were found for both clinical outcomes (SFS: yes/no: β = .30, 95% CI .16 - .43); QALYs: β = .019, 95% CI .01 - .03). From a societal perspective, iCBT-I had a 94% probability of dominating WLC for both clinical outcomes. From a public healthcare perspective, iCBT-I was more effective but also more expensive than WLC, resulting in an incremental cost-effectiveness ratio (ICER) of €650 per symptom-free individual. In terms of QALYs, the ICER 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. Clinical Trial: German Clinical Trial Registry: DRKS00004700; Online Recovery Training for better sleep in teachers with high occupational strain; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004700 (Archived at: https://web.archive.org/web/20201106094150/https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004700)
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