Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs

• Published in: Journal of clinical sleep medicine 2014-02, Vol.10 (2), p.127-135
• Main Authors: McCrae, Christina S, Bramoweth, Adam D, Williams, Jacob, Roth, Alicia, Mosti, Caterina
• Format: Article
• Language: English
• Subjects: Cognitive Therapy - economics; Cognitive Therapy - methods; Female; Health Care Costs - statistics & numerical data; Humans; Male; Middle Aged; New Research; Outpatients - statistics & numerical data; Primary Health Care - economics; Primary Health Care - methods; Primary Health Care - statistics & numerical data; Retrospective Studies; Sleep Initiation and Maintenance Disorders - economics; Sleep Initiation and Maintenance Disorders - therapy; Treatment Outcome
• ISSN: 1550-9389; 1550-9397
• DOI: 10.5664/jcsm.3436

To examine health care utilization (HCU) and costs following brief cognitive behavioral treatment for insomnia (bCBTi). Reviewed medical records of 84 outpatients [mean age = 54.25 years (19.08); 58% women] treated in a behavioral sleep medicine clinic (2005-2010) based in an accredited sleep disorders center. Six indicators of HCU and costs were obtained: estimated total and outpatient costs, estimated primary care visits, CPT costs, number of office visits, and number of medications. All patients completed ≥ 1 session of bCBTi. Those who attended ≥ 3 sessions were considered completers (n = 37), and completers with significant sleep improvements were considered responders (n = 32). For completers and responders, all HCU and cost variables, except number of medications, significantly decreased (ps < 0.05) or trended towards decrease at post-treatment. Completers had average decreases in CPT costs of $200 and estimated total costs of $75. Responders had average decreases in CPT costs of $210. No significant decreases occurred for non-completers. bCBTi can reduce HCU and costs. Response to bCBTi resulted in greater reduction of HCU and costs. While limited by small sample size and non-normal data distribution, the findings highlight the need for greater dissemination of bCBTi for several reasons: a high percentage of completers responded to treatment, as few as 3 sessions can result in significant improvements in insomnia severity, bCBTi can be delivered by novice clinicians, and health care costs can reduce following treatment. Insomnia remains an undertreated disorder, and brief behavioral treatments can help to increase access to care and reduce the burden of insomnia.