CBT for Insomnia Effective, Saves Healthcare Costs

Megan Brooks

February 19, 2014

Brief cognitive-behavioral therapy for insomnia (CBTi) can reduce healthcare utilization and costs, new research shows.

Sleep improved in most insomnia patients who completed at least 3 sessions of CBTi, and their healthcare utilization decreased and healthcare-related costs fell by more than $200 on average, the researchers found.

"CBTi is a highly effective treatment, and this study shows that a relatively brief intervention also may have a positive economic impact," principal investigator Christina McCrae, PhD, associate professor of clinical and health psychology at the University of Florida in Gainesville, said in a statement.

The study was published in the February 15 issue of the Journal of Clinical Sleep Medicine.

Dr. McCrae and colleagues reviewed the medical records of 84 adults treated for insomnia at the Insomnia and Behavioral Sleep Medicine (IBSM) Clinic at the University of Florida and Shands Sleep Disorders Center in Gainesville. The mean age of the patients was 54 years, and 58% were women.

The patients were offered up to 6 weekly sessions of CBTi led by clinical psychology and graduate students and predoctoral interns. Components of the program included sleep education, sleep hygiene, stimulus control therapy, sleep restriction, a 10-minute relaxation exercise, and cognitive therapy, plus a patient workbook.

All patients completed at least 1 session of CBTi. Thirty-seven patients attended 3 or more sessions and were considered "completers"; 32 of these patients, or 86%, saw significant improvement in sleep following CBTi and were considered "responders."

Promising New Evidence

During a 6-month period prior to and following CBTi, the investigators measured the number of physician office visits, costs related to office visits (CPT costs), number of medications, and estimated healthcare costs and utilization.

For completers and responders, all healthcare utilization and cost variables, except number of medications, decreased significantly (P < .05) or trended downward at posttreatment.

For completers, the average decrease in CPT costs was $200, and estimated total costs were $75. For responders, the average decrease in CPT costs was $210. No significant decreases occurred for noncompleters (those who completed fewer than 3 sessions).

The investigators note that the cost of brief CBTi ― about $460 in this study ― may cancel out any savings in the short term, but it has the potential to yield substantial savings in the long term, especially when individual results are extrapolated to the large population of insomnia patients in the healthcare system.

They add that CBTi has been shown to reduce the use of medications and psychiatric symptoms, and these factors would likely contribute to further reductions in healthcare utilization and costs following CBTi.

In a statement, Michael T. Smith, PhD, president of the Society of Behavioral Sleep Medicine, points out that each year in the United States, "millions of prescriptions are filled and billions of dollars are spent to treat insomnia."

"This study reaffirms that cognitive-behavioral therapy is clinically effective, and it provides promising new evidence that even brief treatment with CBTi may reduce healthcare utilization costs," he said.

The study had no commercial funding. The authors report no relevant financial relationships.

J Clin Sleep Med. 2014;10:127-135. Abstract

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