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

Hanne Thiart, David Daniel Ebert, Dirk Lehr, Stephanie Nobis, Claudia Buntrock, Matthias Berking, Filip Smit, Heleen Riper

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)1769-1778
Number of pages10
JournalSleep
Volume39
Issue number10
DOIs
Publication statusPublished - 1 Oct 2016

Cite this

Thiart, H., Ebert, D. D., Lehr, D., Nobis, S., Buntrock, C., Berking, M., ... Riper, H. (2016). Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation. Sleep, 39(10), 1769-1778. https://doi.org/10.5665/sleep.6152
Thiart, Hanne ; Ebert, David Daniel ; Lehr, Dirk ; Nobis, Stephanie ; Buntrock, Claudia ; Berking, Matthias ; Smit, Filip ; Riper, Heleen. / Internet-Based Cognitive Behavioral Therapy for Insomnia : A Health Economic Evaluation. In: Sleep. 2016 ; Vol. 39, No. 10. pp. 1769-1778.
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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.",
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Thiart, H, Ebert, DD, Lehr, D, Nobis, S, Buntrock, C, Berking, M, Smit, F & Riper, H 2016, 'Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation' Sleep, vol. 39, no. 10, pp. 1769-1778. https://doi.org/10.5665/sleep.6152

Internet-Based Cognitive Behavioral Therapy for Insomnia : A Health Economic Evaluation. / Thiart, Hanne; Ebert, David Daniel; Lehr, Dirk; Nobis, Stephanie; Buntrock, Claudia; Berking, Matthias; Smit, Filip; Riper, Heleen.

In: Sleep, Vol. 39, No. 10, 01.10.2016, p. 1769-1778.

Research output: Contribution to journalArticleAcademicpeer-review

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 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.

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 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.

KW - cost-benefit

KW - cost-effectiveness

KW - employer perspective

KW - insomnia

KW - Internet

KW - randomized controlled trial

KW - self-help

U2 - 10.5665/sleep.6152

DO - 10.5665/sleep.6152

M3 - Article

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JO - Sleep

JF - Sleep

SN - 0161-8105

IS - 10

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Thiart H, Ebert DD, Lehr D, Nobis S, Buntrock C, Berking M et al. Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation. Sleep. 2016 Oct 1;39(10):1769-1778. https://doi.org/10.5665/sleep.6152