Cost-effectiveness of cognitive behavioral therapy for insomnia comorbid with depression: Analysis of a randomized controlled trial

Norio Watanabe, Toshiaki A. Furukawa, Shinji Shimodera, Fujika Katsuki, Hirokazu Fujita, Megumi Sasaki, Mitsuhiro Sado, Michael L. Perlis

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Aim Although the efficacy of cognitive behavioral therapy for insomnia has been confirmed, dissemination depends on the balance of benefits and costs. This study aimed to examine the cost-effectiveness of cognitive behavioral therapy for insomnia consisting of four weekly individual sessions. Methods We conducted a 4-week randomized controlled trial with a 4-week follow up in outpatient clinics in Japan. Thirty-seven patients diagnosed as having major depressive disorder according to DSM-IV and suffering from chronic insomnia were randomized to receive either treatment as usual (TAU) alone or TAU plus cognitive behavioral therapy for insomnia. Effectiveness was evaluated as quality-adjusted life years (QALY) over 8 weeks' time, estimated by bootstrapping of the observed total scores of the Hamilton Depression Rating Scale. Direct medical costs for cognitive behavioral therapy for insomnia and TAU were also evaluated. We calculated the incremental cost-effectiveness ratio. Results Over the 8 weeks of the study, the group receiving cognitive behavioral therapy for insomnia plus TAU had significantly higher QALY (P = 0.002) than the TAU-alone group with an incremental value of 0.019 (SD 0.006), and had non-significantly higher costs with an incremental value of 254 (SD 203) USD in direct costs. The incremental cost-effectiveness ratio was 13 678 USD (95% confidence interval: -5691 to 71 316). Adding cognitive behavioral therapy for insomnia demonstrated an approximately 95% chance of gaining one more QALY if a decision-maker was willing to pay 60 000 USD, and approximately 90% for 40 000 USD. Conclusion Adding cognitive behavioral therapy for insomnia is highly likely to be cost-effective for patients with residual insomnia and concomitant depression.

Original languageEnglish
Pages (from-to)335-343
Number of pages9
JournalPsychiatry and Clinical Neurosciences
Volume69
Issue number6
DOIs
Publication statusPublished - 2015 Jun 1

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Sleep Initiation and Maintenance Disorders
Cognitive Therapy
Cost-Benefit Analysis
Randomized Controlled Trials
Depression
Quality-Adjusted Life Years
Costs and Cost Analysis
Therapeutics
Major Depressive Disorder
Ambulatory Care Facilities
Diagnostic and Statistical Manual of Mental Disorders
Japan
Confidence Intervals

Keywords

  • behavior therapy
  • cost-benefit analysis
  • depressive disorder
  • resource allocation
  • sleep initiation and maintenance disorders

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Psychiatry and Mental health
  • Neuroscience(all)

Cite this

Cost-effectiveness of cognitive behavioral therapy for insomnia comorbid with depression : Analysis of a randomized controlled trial. / Watanabe, Norio; Furukawa, Toshiaki A.; Shimodera, Shinji; Katsuki, Fujika; Fujita, Hirokazu; Sasaki, Megumi; Sado, Mitsuhiro; Perlis, Michael L.

In: Psychiatry and Clinical Neurosciences, Vol. 69, No. 6, 01.06.2015, p. 335-343.

Research output: Contribution to journalArticle

Watanabe, Norio ; Furukawa, Toshiaki A. ; Shimodera, Shinji ; Katsuki, Fujika ; Fujita, Hirokazu ; Sasaki, Megumi ; Sado, Mitsuhiro ; Perlis, Michael L. / Cost-effectiveness of cognitive behavioral therapy for insomnia comorbid with depression : Analysis of a randomized controlled trial. In: Psychiatry and Clinical Neurosciences. 2015 ; Vol. 69, No. 6. pp. 335-343.
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AB - Aim Although the efficacy of cognitive behavioral therapy for insomnia has been confirmed, dissemination depends on the balance of benefits and costs. This study aimed to examine the cost-effectiveness of cognitive behavioral therapy for insomnia consisting of four weekly individual sessions. Methods We conducted a 4-week randomized controlled trial with a 4-week follow up in outpatient clinics in Japan. Thirty-seven patients diagnosed as having major depressive disorder according to DSM-IV and suffering from chronic insomnia were randomized to receive either treatment as usual (TAU) alone or TAU plus cognitive behavioral therapy for insomnia. Effectiveness was evaluated as quality-adjusted life years (QALY) over 8 weeks' time, estimated by bootstrapping of the observed total scores of the Hamilton Depression Rating Scale. Direct medical costs for cognitive behavioral therapy for insomnia and TAU were also evaluated. We calculated the incremental cost-effectiveness ratio. Results Over the 8 weeks of the study, the group receiving cognitive behavioral therapy for insomnia plus TAU had significantly higher QALY (P = 0.002) than the TAU-alone group with an incremental value of 0.019 (SD 0.006), and had non-significantly higher costs with an incremental value of 254 (SD 203) USD in direct costs. The incremental cost-effectiveness ratio was 13 678 USD (95% confidence interval: -5691 to 71 316). Adding cognitive behavioral therapy for insomnia demonstrated an approximately 95% chance of gaining one more QALY if a decision-maker was willing to pay 60 000 USD, and approximately 90% for 40 000 USD. Conclusion Adding cognitive behavioral therapy for insomnia is highly likely to be cost-effective for patients with residual insomnia and concomitant depression.

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