@Article{info:doi/10.2196/25609,
author="Buntrock, Claudia
and Lehr, Dirk
and Smit, Filip
and Horvath, Hanne
and Berking, Matthias
and Spiegelhalder, Kai
and Riper, Heleen
and Ebert, David Daniel",
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",
journal="J Med Internet Res",
year="2021",
month="May",
day="24",
volume="23",
number="5",
pages="e25609",
keywords="insomnia; internet-based cognitive behavioural therapy; iCBT-I; economic evaluation; cost-effectiveness; cost-utility; cognitive behavioral therapy; behavior; sleep; economics; public health; perspective",
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: $\beta$=.30; 95{\%} CI 0.16-0.43; QALYs: $\beta$=.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 {\texteuro}650 per symptom-free individual. In terms of QALYs, the incremental cost-effectiveness ratio was {\texteuro}11,285. At a willingness-to-pay threshold of {\texteuro}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 ",
issn="1438-8871",
doi="10.2196/25609",
url="https://www.jmir.org/2021/5/e25609",
url="https://doi.org/10.2196/25609",
url="http://www.ncbi.nlm.nih.gov/pubmed/34028361"
}