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Sleep. 2016 Oct 1;39(10):1769-1778.

Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation.

Author information

1
Innovation Incubator, Division of Health Training Online, Leuphana University Lueneburg, Lueneburg, Germany.
2
Department of Clinical Psychology and Psychotherapy, University Erlangen-Nuremberg, Erlangen, Germany.
3
Leuphana University Lueneburg, Institute of Psychology, Lueneburg, Germany.
4
Department of Clinical, Developmental and Neuro Psychology, Section of Clinical Psychology, Vrije Universiteit, EMGO+ Institute for Health and Care Research, VUmc, Amsterdam, The Netherlands.
5
Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental health and Addiction), Utrecht, The Netherlands.
6
Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands.
7
Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.

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

Comment in

PMID:
27450686
PMCID:
PMC5020359
DOI:
10.5665/sleep.6152
[Indexed for MEDLINE]
Free PMC Article

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