Hanne Thiart1, David Daniel Ebert2, Dirk Lehr1,3, Stephanie Nobis1, Claudia Buntrock1,4, Matthias Berking2, Filip Smit5,6,7, Heleen Riper4. 1. Innovation Incubator, Division of Health Training Online, Leuphana University Lueneburg, Lueneburg, Germany. 2. Department of Clinical Psychology and Psychotherapy, University Erlangen-Nuremberg, Erlangen, Germany. 3. Leuphana University Lueneburg, Institute of Psychology, Lueneburg, Germany. 4. Department of Clinical, Developmental and Neuro Psychology, Section of Clinical Psychology, Vrije Universiteit, EMGO+ Institute for Health and Care Research, VUmc, Amsterdam, The Netherlands. 5. Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental health and Addiction), Utrecht, The Netherlands. 6. Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands. 7. Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Abstract
STUDY OBJECTIVES: Lost productivity caused by insomnia is a common and costly problem for employers. Although evidence for the efficacy of Internet-based cognitive behavioral therapy for insomnia (iCBT-I) already exists, little is known about its economic effects. This study aims to evaluate the cost-effectiveness and cost-benefit of providing iCBT-I to symptomatic employees from the employer's perspective. METHODS:School teachers (N = 128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a waitlist-control-group, both with access to treatment as usual. Economic data were collected at baseline and 6-mo follow-up. We conducted (1) a cost-effectiveness analysis with treatment response (Reliable Change [decline of 5.01 points] and Insomnia Severity Index < 8 at 6-month follow-up) as the outcome and (2) a cost-benefit analysis. Because both analyses were performed from the employer's perspective, we focused specifically on absenteeism and presenteeism costs. Statistical uncertainty was estimated using bootstrapping. RESULTS: Assuming intervention costs of €200 ($245), cost-effectiveness analyses showed that at a willingness-to-pay of €0 for each positive treatment response, there is an 87% probability that the intervention is more cost effective than treatment as usual alone. Cost-benefit analyses led to a net benefit of €418 (95% confidence interval: -593.03 to 1,488.70) ($512) per participant and a return on investment of 208% (95% confidence interval: -296.52 to 744.35). The reduction in costs was mainly driven by the effects of the intervention on presenteeism and to a lesser degree by reduced absenteeism. CONCLUSIONS: Focusing on sleep improvement using iCBT-I may be a cost-effective strategy in occupational health care. CLINICAL TRIALS REGISTRATION: Title: Online Recovery Training for Better Sleep in Teachers with High Psychological Strain. German Clinical Trial Register (DRKS), URL: https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004700. Identifier: DRKS00004700. COMMENTARY: A commentary on this article appears in this issue on page 1767.
RCT Entities:
STUDY OBJECTIVES: Lost productivity caused by insomnia is a common and costly problem for employers. Although evidence for the efficacy of Internet-based cognitive behavioral therapy for insomnia (iCBT-I) already exists, little is known about its economic effects. This study aims to evaluate the cost-effectiveness and cost-benefit of providing iCBT-I to symptomatic employees from the employer's perspective. METHODS: School teachers (N = 128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a waitlist-control-group, both with access to treatment as usual. Economic data were collected at baseline and 6-mo follow-up. We conducted (1) a cost-effectiveness analysis with treatment response (Reliable Change [decline of 5.01 points] and Insomnia Severity Index < 8 at 6-month follow-up) as the outcome and (2) a cost-benefit analysis. Because both analyses were performed from the employer's perspective, we focused specifically on absenteeism and presenteeism costs. Statistical uncertainty was estimated using bootstrapping. RESULTS: Assuming intervention costs of €200 ($245), cost-effectiveness analyses showed that at a willingness-to-pay of €0 for each positive treatment response, there is an 87% probability that the intervention is more cost effective than treatment as usual alone. Cost-benefit analyses led to a net benefit of €418 (95% confidence interval: -593.03 to 1,488.70) ($512) per participant and a return on investment of 208% (95% confidence interval: -296.52 to 744.35). The reduction in costs was mainly driven by the effects of the intervention on presenteeism and to a lesser degree by reduced absenteeism. CONCLUSIONS: Focusing on sleep improvement using iCBT-I may be a cost-effective strategy in occupational health care. CLINICAL TRIALS REGISTRATION: Title: Online Recovery Training for Better Sleep in Teachers with High Psychological Strain. German Clinical Trial Register (DRKS), URL: https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004700. Identifier: DRKS00004700. COMMENTARY: A commentary on this article appears in this issue on page 1767.
Authors: Frances P Thorndike; Lee M Ritterband; Drew K Saylor; Joshua C Magee; Linda A Gonder-Frederick; Charles M Morin Journal: Behav Sleep Med Date: 2011 Impact factor: 2.964
Authors: Ronald C Kessler; Patricia A Berglund; Catherine Coulouvrat; Goeran Hajak; Thomas Roth; Victoria Shahly; Alicia C Shillington; Judith J Stephenson; James K Walsh Journal: Sleep Date: 2011-09-01 Impact factor: 5.849
Authors: Don Husereau; Michael Drummond; Stavros Petrou; Chris Carswell; David Moher; Dan Greenberg; Federico Augustovski; Andrew H Briggs; Josephine Mauskopf; Elizabeth Loder Journal: Value Health Date: 2013 Mar-Apr Impact factor: 5.725
Authors: Johanna M van Dongen; Marieke F van Wier; Emile Tompa; Paulien M Bongers; Allard J van der Beek; Maurits W van Tulder; Judith E Bosmans Journal: J Occup Environ Med Date: 2014-06 Impact factor: 2.162
Authors: Tori L Crain; Leslie B Hammer; Todd Bodner; Ryan Olson; Ellen Ernst Kossek; Phyllis Moen; Orfeu M Buxton Journal: J Occup Health Psychol Date: 2018-05-28
Authors: Leeanne Nicklas; Mairi Albiston; Martin Dunbar; Alan Gillies; Jennifer Hislop; Helen Moffat; Judy Thomson Journal: BMC Health Serv Res Date: 2022-09-07 Impact factor: 2.908
Authors: Emerson M Wickwire; Sarah E Tom; Steven M Scharf; Aparna Vadlamani; Ilynn G Bulatao; Jennifer S Albrecht Journal: Sleep Date: 2019-04-01 Impact factor: 5.849
Authors: Kelly M Shaffer; Eric A Finkelstein; Fabian Camacho; Karen S Ingersoll; Frances Thorndike; Lee M Ritterband Journal: Ann Behav Med Date: 2021-06-02
Authors: Jack D Edinger; J Todd Arnedt; Suzanne M Bertisch; Colleen E Carney; John J Harrington; Kenneth L Lichstein; Michael J Sateia; Wendy M Troxel; Eric S Zhou; Uzma Kazmi; Jonathan L Heald; Jennifer L Martin Journal: J Clin Sleep Med Date: 2021-02-01 Impact factor: 4.062