School of Economics and Finance, Massey University, Wellington, New Zealand.
Cost Eff Resour Alloc. 2011 Jun 21;9:10. doi: 10.1186/1478-7547-9-10.
Insomnia is perhaps the most common sleep disorder in the general population, and is characterised by a range of complaints around difficulties in initiating and maintaining sleep, together with impaired waking function. There is little quantitative information on treatment pathways, costs and outcomes. The aims of this New Zealand study were to determine from which healthcare practitioners patients with insomnia sought treatment, treatment pathways followed, the net costs of treatment and the quality of life improvements obtained.
The study was retrospective and prevalence based, and was both cost effectiveness (CEA) and a cost utility (CUA) analysis. Micro costing techniques were used and a societal analytic perspective was adopted. A deterministic decision tree model was used to estimate base case values, and a stochastic version, with Monte Carlo simulation, was used to perform sensitivity analysis. A probability and cost were attached to each event which enabled the costs for the treatment pathways and average treatment cost to be calculated. The inputs to the model were prevalence, event probabilities, resource utilisations, and unit costs. Direct costs and QALYs gained were evaluated.
The total net benefit of treating a person with insomnia was $482 (the total base case cost of $145 less health costs avoided of $628). When these results were applied to the total at-risk population in New Zealand additional treatment costs incurred were $6.6 million, costs avoided $28.4 million and net benefits were $21.8 million. The incremental net benefit when insomnia was "successfully" treated was $3,072 per QALY gained.
The study has brought to light a number of problems relating to the treatment of insomnia in New Zealand. There is both inadequate access to publicly funded treatment and insufficient publicly available information from which a consumer is able to make an informed decision on the treatment and provider options. This study suggests that successful treatment of insomnia leads to direct cost savings and improved quality of life.
失眠或许是普通人群中最常见的睡眠障碍，其特征是存在一系列入睡和维持睡眠困难、以及觉醒功能受损相关的主诉。关于治疗途径、成本和结果的定量信息较少。本新西兰研究的目的是确定失眠患者从哪些医疗保健从业者那里寻求治疗、遵循的治疗途径、治疗的净成本以及获得的生活质量改善。
该研究为回顾性和基于患病率的研究，同时进行成本效益分析（CEA）和成本效用分析（CUA）。采用微观成本核算技术，并采用社会分析视角。使用确定性决策树模型估计基本情况值，并使用具有蒙特卡罗模拟的随机版本进行敏感性分析。为每个事件分配概率和成本，从而能够计算治疗途径的成本和平均治疗成本。模型的输入为患病率、事件概率、资源利用和单位成本。评估了直接成本和获得的 QALYs。
治疗失眠患者的总净收益为 482 美元（总基本情况成本 145 美元减去避免的健康成本 628 美元）。当将这些结果应用于新西兰的总风险人群时，额外的治疗费用为 660 万美元，避免的费用为 2840 万美元，净收益为 2180 万美元。成功治疗失眠时，每获得一个 QALY 的增量净收益为 3072 美元。
该研究揭示了一些与新西兰失眠治疗相关的问题。在获得公共资助治疗和缺乏消费者能够根据治疗和提供者选择做出明智决策的公共可用信息方面，都存在不足。本研究表明，成功治疗失眠可带来直接成本节约和生活质量改善。
