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

AIM: Although the efficacy of cognitive behavioral therapy for insomnia has been confirmed, dissemination depends on the balance of benefits and costs. The study aimed to examine the cost-effectiveness of cognitive behavioral therapy for insomnia consisting of 4 weekly individual sessions. METHODS: We conducted a 4-week randomized controlled trial with 4-week follow-up in outpatient clinics in Japan. Thirty-seven patients diagnosed as major depressive disorder with DSM-IV and suffering from chronic insomnia were randomized to either treatment as usual (TAU) alone or TAU plus cognitive behavioral therapy for insomnia. Effectiveness was evaluated as Quality-Adjusted Life Years (QALYs) 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 8 weeks of the study, cognitive behavioral therapy for insomnia plus TAU group had significantly higher QALYs (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%CI: -5,691 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 for 60,000 USD, and approximately 90% for 40,000. CONCLUSION: Adding cognitive behavioral therapy for insomnia is highly likely to be cost-effective for patients with residual insomnia and concomitant depression. Language: en