Guided internet-based cognitive behavioral therapy for insomnia: Health-economic evaluation from the societal and public health care perspective alongside a randomized controlled trial

Claudia Buntrock; Dirk Lehr; Filip Smit; Hanne Horvath; Matthias Berking; Kai Spiegelhalder; Heleen Riper; David Daniel Ebert

doi:10.2196/25609

Guided internet-based cognitive behavioral therapy for insomnia: Health-economic evaluation from the societal and public health care perspective alongside a randomized controlled trial

Claudia Buntrock^*
, Dirk Lehr
, Filip Smit
, Hanne Horvath
, Matthias Berking
, Kai Spiegelhalder
, Heleen Riper
, David Daniel Ebert

^*Corresponding author for this work

Institute of Psychology in Education

Research output: Journal contributions › Journal articles › Research › peer-review

21 Citations (Scopus)

Abstract

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.

Original language	English
Article number	e25609
Journal	Journal of Medical Internet Research
Volume	23
Issue number	5
ISSN	1439-4456
DOIs	https://doi.org/10.2196/25609
Publication status	Published - 24.05.2021

Bibliographical note

This was not an industry-supported study. The European Union funded this study (European Regional Development Fund: ZW6-80119999 and CCI 2007DE161PR001). The funder did not have a role in study design; data collection, analysis, and interpretation of results; or the decision to publish the study results.

©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.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research areas and keywords

Behavior
Cognitive behavioral therapy
Cost-effectiveness
Cost-utility
Economic evaluation
Economics
ICBT-I
Insomnia
Internet-based cognitive behavioural therapy
Perspective
Public health
Sleep
Psychology
Health sciences

ASJC Scopus Subject Areas

Health Informatics

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Buntrock, C., Lehr, D., Smit, F., Horvath, H., Berking, M., Spiegelhalder, K., Riper, H., & Ebert, D. D. (2021). Guided internet-based cognitive behavioral therapy for insomnia: Health-economic evaluation from the societal and public health care perspective alongside a randomized controlled trial. Journal of Medical Internet Research, 23(5), Article e25609. https://doi.org/10.2196/25609

@article{ebd87f457ffb4890a64be5f1016510cf,

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",

abstract = "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.",

keywords = "Behavior, Cognitive behavioral therapy, Cost-effectiveness, Cost-utility, Economic evaluation, Economics, ICBT-I, Insomnia, Internet-based cognitive behavioural therapy, Perspective, Public health, Sleep, Psychology, Health sciences",

author = "Claudia Buntrock and Dirk Lehr and Filip Smit and Hanne Horvath and Matthias Berking and Kai Spiegelhalder and Heleen Riper and Ebert, \{David Daniel\}",

note = "This was not an industry-supported study. The European Union funded this study (European Regional Development Fund: ZW6-80119999 and CCI 2007DE161PR001). The funder did not have a role in study design; data collection, analysis, and interpretation of results; or the decision to publish the study results. {\textcopyright}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.",

year = "2021",

month = may,

day = "24",

doi = "10.2196/25609",

language = "English",

volume = "23",

journal = "Journal of Medical Internet Research",

issn = "1439-4456",

publisher = "JMIR Publications Inc.",

number = "5",

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Buntrock, C, Lehr, D, Smit, F, Horvath, H, Berking, M, Spiegelhalder, K, Riper, H & Ebert, DD 2021, 'Guided internet-based cognitive behavioral therapy for insomnia: Health-economic evaluation from the societal and public health care perspective alongside a randomized controlled trial', Journal of Medical Internet Research, vol. 23, no. 5, e25609. https://doi.org/10.2196/25609

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 et al.
In: Journal of Medical Internet Research, Vol. 23, No. 5, e25609, 24.05.2021.

Research output: Journal contributions › Journal articles › Research › peer-review

TY - JOUR

T1 - Guided internet-based cognitive behavioral therapy for insomnia

T2 - Health-economic evaluation from the societal and public health care perspective alongside a randomized controlled trial

AU - Buntrock, Claudia

AU - Lehr, Dirk

AU - Smit, Filip

AU - Horvath, Hanne

AU - Berking, Matthias

AU - Spiegelhalder, Kai

AU - Riper, Heleen

AU - Ebert, David Daniel

N1 - This was not an industry-supported study. The European Union funded this study (European Regional Development Fund: ZW6-80119999 and CCI 2007DE161PR001). The funder did not have a role in study design; data collection, analysis, and interpretation of results; or the decision to publish the study results. ©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.

PY - 2021/5/24

Y1 - 2021/5/24

N2 - 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.

AB - 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.

KW - Behavior

KW - Cognitive behavioral therapy

KW - Cost-effectiveness

KW - Cost-utility

KW - Economic evaluation

KW - Economics

KW - ICBT-I

KW - Insomnia

KW - Internet-based cognitive behavioural therapy

KW - Perspective

KW - Public health

KW - Sleep

KW - Psychology

KW - Health sciences

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UR - https://www.mendeley.com/catalogue/ab5ec0e4-3506-3b91-bd97-81b078a4a869/

U2 - 10.2196/25609

DO - 10.2196/25609

M3 - Journal articles

C2 - 34028361

AN - SCOPUS:85106860525

SN - 1439-4456

VL - 23

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

IS - 5

M1 - e25609

ER -

Guided internet-based cognitive behavioral therapy for insomnia: Health-economic evaluation from the societal and public health care perspective alongside a randomized controlled trial

Abstract

Bibliographical note

UN SDGs

Research areas and keywords

ASJC Scopus Subject Areas

Access to Document

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