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.

中文翻译：

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与一般实践中失眠患者照常护理相比，引导互联网提供的认知行为疗法的成本效益

摘要

学习目标

临床指南推荐失眠的认知行为疗法（CBT-I）作为一线治疗。然而，由于时间和专业知识不足，CBT-I 的提供受到限制。互联网提供的 CBT-I 可能会弥合这一差距。本研究旨在从社会角度评估 26 周内一般实践中指导的、互联网提供的 CBT-I (i-Sleep) 与照常护理失眠患者相比的成本效益。

方法

主要结果是失眠严重程度指数（ISI、连续评分和临床相关反应）和质量调整生命年（QALYs）。在基线、第 8 周和第 26 周评估社会成本。缺失的数据使用多重插补进行插补。使用自举法估计成本和效果差异的统计不确定性，并在成本效益平面和可接受曲线中呈现。

结果

i-Sleep 和照常护理之间的社会成本差异无统计学意义（-318 欧元；95% CI -1282 至 645）。成本效益分析显示，与常规护理相比，i-Sleep 具有 95% 的成本效益概率，上限比率分别为 450 欧元/ISI 评分的额外改善点和 7,000 欧元/额外的治疗反应。成本效用分析显示，与常规护理相比，i-Sleep 的成本效益概率为 67%，上限比率为 20,000 欧元/QALY。

结论

从社会角度来看，与照常护理相比，互联网提供的干预可能被认为对失眠严重程度具有成本效益。然而，失眠严重程度症状的改善并没有导致 QALYs 的类似改善。