A retrospective cost‐effectiveness analysis of different cognitive‐behavioral therapy for insomnia intervention delivery approaches in adult cancer survivors

Abstract

AbstractBackgroundCognitive‐behavioral therapy for insomnia (CBT‐I) is considered the gold standard treatment for insomnia. Prior trials have delivered CBT‐I across a range of treatment sessions. Understanding the economics of varying treatment approaches is essential for future implementation considerations.MethodsWe conducted a retrospective cost‐effectiveness analysis from the provider's perspective, comparing the implementation of a three‐session CBT‐I program for cancer survivors (CBT‐I‐CS) versus a stepped care treatment approach consisting of an initial single sleep education session followed by CBT‐I‐CS if elevated insomnia symptoms persisted. The effectiveness measure used was the percentage of participants whose insomnia had remitted by the end of each program.ResultsStepped care delivery was more effective than CBT‐I‐CS alone, resulting in 35.4% more remitted patients by the end of the overall program. For a $480 willingness to pay threshold per percentage of remitted patients, stepped care CBT‐I‐CS reached a 98% probability of being cost‐effective, while CBT‐I‐CS alone had only a 2% probability. Larger group sessions in the first step of a stepped care delivery model resulted in more favorable cost‐effectiveness.ConclusionsA stepped care delivery model may be a more cost‐effective approach if it can be implemented efficiently. These findings inform policies aimed at improving cancer survivors' access to much‐needed insomnia treatment in settings where financial resources for CBT‐I may be limited, and be an important barrier to treatment dissemination.Clinical Trial RegistrationThese analyses were not registered.