Skip to main content
Journal cover image

Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States.

Publication ,  Journal Article
Darden, M; Espie, CA; Carl, JR; Henry, AL; Kanady, JC; Krystal, AD; Miller, CB
Published in: Sleep
April 9, 2021

STUDY OBJECTIVES: To examine the cost-effectiveness and potential net monetary benefit (NMB) of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group). METHODS: We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g. insomnia-related healthcare expenditure and lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth 50,000.Simulatedindividualswererandomizedequallytooneoffivearms(digitalCBT,pharmacotherapy,individualCBT,groupCBT,ornoinsomniatreatment).Sensitivitywasassessedbybootstrappingthecalibratedparameters.Costestimateswereexpressedin2019USdollars.RESULTS:DigitalCBTwascostbeneficialwhencomparedwithnoinsomniatreatmentandhadapositiveNMBof681.06 (per individual over 6 months). Bootstrap sensitivity analysis demonstrated that the NMB was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (-$3,124.73). CONCLUSIONS: Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.

Duke Scholars

Published In

Sleep

DOI

EISSN

1550-9109

Publication Date

April 9, 2021

Volume

44

Issue

4

Location

United States

Related Subject Headings

  • United States
  • Sleep Initiation and Maintenance Disorders
  • Quality-Adjusted Life Years
  • Neurology & Neurosurgery
  • Humans
  • Health Care Costs
  • Cost-Benefit Analysis
  • Cognitive Behavioral Therapy
  • 52 Psychology
  • 32 Biomedical and clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Darden, M., Espie, C. A., Carl, J. R., Henry, A. L., Kanady, J. C., Krystal, A. D., & Miller, C. B. (2021). Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States. Sleep, 44(4). https://doi.org/10.1093/sleep/zsaa223
Journal cover image

Published In

Sleep

DOI

EISSN

1550-9109

Publication Date

April 9, 2021

Volume

44

Issue

4

Location

United States

Related Subject Headings

  • United States
  • Sleep Initiation and Maintenance Disorders
  • Quality-Adjusted Life Years
  • Neurology & Neurosurgery
  • Humans
  • Health Care Costs
  • Cost-Benefit Analysis
  • Cognitive Behavioral Therapy
  • 52 Psychology
  • 32 Biomedical and clinical sciences