Cargando…
Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Health-Economic Evaluation From the Societal and Public Health Care Perspective Alongside a Randomized Controlled Trial
BACKGROUND: The evidence base for internet-based cognitive behavioral 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 in reducing insomnia among schooltea...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185611/ https://www.ncbi.nlm.nih.gov/pubmed/34028361 http://dx.doi.org/10.2196/25609 |
_version_ | 1783704822360309760 |
---|---|
author | Buntrock, Claudia Lehr, Dirk Smit, Filip Horvath, Hanne Berking, Matthias Spiegelhalder, Kai Riper, Heleen Ebert, David Daniel |
author_facet | Buntrock, Claudia Lehr, Dirk Smit, Filip Horvath, Hanne Berking, Matthias Spiegelhalder, Kai Riper, Heleen Ebert, David Daniel |
author_sort | Buntrock, Claudia |
collection | PubMed |
description | BACKGROUND: The evidence base for internet-based cognitive behavioral 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 in reducing insomnia among schoolteachers. METHODS: Schoolteachers (N=128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a wait list control group, both with unrestricted access to treatment as usual. Health care 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 (score <8 on the insomnia severity index) and quality-adjusted life years (QALYs) gained. Sampling error was handled using nonparametric bootstrapping. RESULTS: Statistically significant differences favoring the intervention group were found for both health outcomes (symptom-free status yes or no: β=.30; 95% CI 0.16-0.43; QALYs: β=.019, 95% CI 0.01-0.03). From a societal perspective, iCBT-I had a 94% probability of dominating the wait list control for both health outcomes. From a public health care perspective, iCBT-I was more effective but also more expensive than the wait list control, resulting in an incremental cost-effectiveness ratio of €650 per symptom-free individual. In terms of QALYs, the incremental cost-effectiveness ratio 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. TRIAL REGISTRATION: German Clinical Trial Registry: DRKS00004700; https://tinyurl.com/2nnk57jm INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1745-6215-14-169 |
format | Online Article Text |
id | pubmed-8185611 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-81856112021-06-25 Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Health-Economic Evaluation From the Societal and Public Health Care Perspective Alongside a Randomized Controlled Trial Buntrock, Claudia Lehr, Dirk Smit, Filip Horvath, Hanne Berking, Matthias Spiegelhalder, Kai Riper, Heleen Ebert, David Daniel J Med Internet Res Original Paper BACKGROUND: The evidence base for internet-based cognitive behavioral 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 in reducing insomnia among schoolteachers. METHODS: Schoolteachers (N=128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a wait list control group, both with unrestricted access to treatment as usual. Health care 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 (score <8 on the insomnia severity index) and quality-adjusted life years (QALYs) gained. Sampling error was handled using nonparametric bootstrapping. RESULTS: Statistically significant differences favoring the intervention group were found for both health outcomes (symptom-free status yes or no: β=.30; 95% CI 0.16-0.43; QALYs: β=.019, 95% CI 0.01-0.03). From a societal perspective, iCBT-I had a 94% probability of dominating the wait list control for both health outcomes. From a public health care perspective, iCBT-I was more effective but also more expensive than the wait list control, resulting in an incremental cost-effectiveness ratio of €650 per symptom-free individual. In terms of QALYs, the incremental cost-effectiveness ratio 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. TRIAL REGISTRATION: German Clinical Trial Registry: DRKS00004700; https://tinyurl.com/2nnk57jm INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1745-6215-14-169 JMIR Publications 2021-05-24 /pmc/articles/PMC8185611/ /pubmed/34028361 http://dx.doi.org/10.2196/25609 Text en ©Claudia Buntrock, Dirk Lehr, Filip Smit, Hanne Horvath, Matthias Berking, Kai Spiegelhalder, Heleen Riper, David Daniel Ebert. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 24.05.2021. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Buntrock, Claudia Lehr, Dirk Smit, Filip Horvath, Hanne Berking, Matthias Spiegelhalder, Kai Riper, Heleen Ebert, David Daniel Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Health-Economic Evaluation From the Societal and Public Health Care Perspective Alongside a Randomized Controlled Trial |
title | Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Health-Economic Evaluation From the Societal and Public Health Care Perspective Alongside a Randomized Controlled Trial |
title_full | Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Health-Economic Evaluation From the Societal and Public Health Care Perspective Alongside a Randomized Controlled Trial |
title_fullStr | Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Health-Economic Evaluation From the Societal and Public Health Care Perspective Alongside a Randomized Controlled Trial |
title_full_unstemmed | Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Health-Economic Evaluation From the Societal and Public Health Care Perspective Alongside a Randomized Controlled Trial |
title_short | Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Health-Economic Evaluation From the Societal and Public Health Care Perspective Alongside a Randomized Controlled Trial |
title_sort | guided internet-based cognitive behavioral therapy for insomnia: health-economic evaluation from the societal and public health care perspective alongside a randomized controlled trial |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185611/ https://www.ncbi.nlm.nih.gov/pubmed/34028361 http://dx.doi.org/10.2196/25609 |
work_keys_str_mv | AT buntrockclaudia guidedinternetbasedcognitivebehavioraltherapyforinsomniahealtheconomicevaluationfromthesocietalandpublichealthcareperspectivealongsidearandomizedcontrolledtrial AT lehrdirk guidedinternetbasedcognitivebehavioraltherapyforinsomniahealtheconomicevaluationfromthesocietalandpublichealthcareperspectivealongsidearandomizedcontrolledtrial AT smitfilip guidedinternetbasedcognitivebehavioraltherapyforinsomniahealtheconomicevaluationfromthesocietalandpublichealthcareperspectivealongsidearandomizedcontrolledtrial AT horvathhanne guidedinternetbasedcognitivebehavioraltherapyforinsomniahealtheconomicevaluationfromthesocietalandpublichealthcareperspectivealongsidearandomizedcontrolledtrial AT berkingmatthias guidedinternetbasedcognitivebehavioraltherapyforinsomniahealtheconomicevaluationfromthesocietalandpublichealthcareperspectivealongsidearandomizedcontrolledtrial AT spiegelhalderkai guidedinternetbasedcognitivebehavioraltherapyforinsomniahealtheconomicevaluationfromthesocietalandpublichealthcareperspectivealongsidearandomizedcontrolledtrial AT riperheleen guidedinternetbasedcognitivebehavioraltherapyforinsomniahealtheconomicevaluationfromthesocietalandpublichealthcareperspectivealongsidearandomizedcontrolledtrial AT ebertdaviddaniel guidedinternetbasedcognitivebehavioraltherapyforinsomniahealtheconomicevaluationfromthesocietalandpublichealthcareperspectivealongsidearandomizedcontrolledtrial |