Cognitive behavioral therapy for insomnia can reduce health care utilization, costs

Results show that sleep improved in 86 percent of insomnia patients who completed at least three sessions of CBTI. In the six months following treatment, health care utilization decreased and health care-related costs were reduced by more than $200 on average among treatment completers.

"Cognitive behavioral therapy for insomnia is a highly effective treatment, and this study shows that a relatively brief intervention also may have a positive economic impact," said principal investigator Christina McCrae, PhD, associate professor of clinical and health psychology at the University of Florida in Gainesville, Fla. "Insomnia remains an undertreated disorder, and brief cognitive behavioral therapy can help to increase access to care and reduce the burden of insomnia."

The study results appear in the Feb. 15 issue of the Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine.

"Each year in the U.S. millions of prescriptions are filled and billions of dollars are spent to treat insomnia," said Society of Behavioral Sleep Medicine President Michael T. Smith, PhD. "This study reaffirms that cognitive behavioral therapy is clinically effective, and it provides promising new evidence that even brief treatment with CBTI may reduce health care utilization costs."

Together with colleagues from the VA Pittsburgh Healthcare System and Drexel University in Philadelphia, McCrae reviewed medical records of 84 outpatients treated in a behavioral sleep medicine clinic based in an accredited sleep disorders center. Components of the treatment included sleep education, sleep hygiene, stimulus control therapy, sleep restriction, a 10-minute relaxation exercise, and cognitive therapy. Up to six weekly treatment sessions were led by clinical psychology graduate students and predoctoral interns. Several indicators of health care utilization and costs were measured over a six-month period prior to and following treatment: number of physician office visits, costs related to office visits, number of medications, and estimated health care costs and utilization.

The authors noted that the cost of brief treatment with CBTI -- about $460 in the study -- may negate the short-term savings produced in the first six months after treatment. However, the advantage of CBTI is that the effects are long-lasting, which means that there are no ongoing treatment costs. Therefore, CBTI has the potential to produce substantial long-term savings, especially when individual results are extrapolated to the large population of insomnia patients in the health care system.