Economic evaluation of cognitive behavioural therapy for insomnia (CBT-I) for improving health outcomes in adult populations: A systematic review

Andrea N Natsky; Andrew Vakulin; Ching L Chai-Coetzer; Leon Lack; R D McEvoy; Nicole Lovato; Alexander Sweetman; Christopher J Gordon; Robert J Adams; Billingsley Kaambwa

doi:10.1016/j.smrv.2020.101351

Economic evaluation of cognitive behavioural therapy for insomnia (CBT-I) for improving health outcomes in adult populations: A systematic review

Sleep Med Rev. 2020 Dec:54:101351. doi: 10.1016/j.smrv.2020.101351. Epub 2020 Jul 9.

Authors

Affiliations

¹ Health Economics, Flinders University, College of Medicine and Public Health, Bedford Park, SA, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Bedford Park, SA, Australia. Electronic address: andrea.natsky@flinders.edu.au.
² National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Bedford Park, SA, Australia; Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; NeuroSleep - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, University of Sydney, NSW, Australia.
³ National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Bedford Park, SA, Australia; Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.
⁴ National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Bedford Park, SA, Australia; Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia.
⁵ National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Bedford Park, SA, Australia; Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
⁶ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, NSW, Australia.
⁷ Health Economics, Flinders University, College of Medicine and Public Health, Bedford Park, SA, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Bedford Park, SA, Australia.

PMID: 32739824
DOI: 10.1016/j.smrv.2020.101351

Abstract

Cognitive behavioural therapy for insomnia (CBT-I) is a promising intervention with established efficacy, yet evidence of its cost-effectiveness remains unclear. Systematic searches were conducted in Medline, Psychinfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare. Titles and abstracts were screened against eligibility criteria, and studies reporting full economic evaluations of CBT-I in adult populations were included and examined in detail. Study characteristics were extracted using a standardised template. Quantitative measures and relevant findings were summarised using a qualitative approach following recommended reporting standards. 1,168 non-duplicate articles were identified, of which 44 were selected for full-text review. Seven full economic evaluations of CBT-I in adult populations met the inclusion criteria and were incorporated in the final synthesis. Using the dominance ranking framework to compare cost and outcomes, CBT-I was cost-effective compared to pharmacotherapy or no treatment. The limited number of studies included in this review implies that caution should be exercised when interpreting these results. Future studies are encouraged to employ longer time-horizons and larger sample sizes to enable better determination of sustained cost and outcomes changes. Prospero registration number: CRD42019133554.

Keywords: Adult; CBT-I; Cost-effectiveness; Economic evaluation; Insomnia; Systematic review.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Cognitive Behavioral Therapy*
Cost-Benefit Analysis / statistics & numerical data*
Humans
Outcome Assessment, Health Care*
Sleep Initiation and Maintenance Disorders / therapy*