Department of Clinical & Health Psychology, University of Florida, Gainesville, FL.
VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC) VA Pittsburgh Healthcare System, Pittsburgh, PA.
J Clin Sleep Med. 2014 Feb 15;10(2):127-35. 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.
考察短期认知行为疗法治疗失眠症（bCBTi）后的医疗保健利用（HCU）和成本。
回顾了一家经过认证的睡眠障碍中心的行为睡眠医学诊所（2005-2010 年）治疗的 84 名门诊患者（平均年龄= 54.25 岁（19.08）；58%为女性）的医疗记录。获得了 HCU 和成本的六个指标：估计的总费用和门诊费用、估计的初级保健就诊次数、CPT 费用、就诊次数和用药次数。所有患者均完成了≥1 次 bCBTi。参加≥3 次的患者被视为完成者（n=37），并且睡眠改善显著的完成者被视为应答者（n=32）。
对于完成者和应答者，除用药次数外，所有 HCU 和成本变量在治疗后均显著降低（p<0.05）或呈下降趋势。完成者的 CPT 费用平均降低 200 美元，总费用估计降低 75 美元。应答者的 CPT 费用平均降低 210 美元。非完成者没有明显的减少。
bCBTi 可以减少 HCU 和成本。对 bCBTi 的反应导致 HCU 和成本的更大减少。尽管受到样本量小和数据分布非正态的限制，但这些发现强调了以下几个原因需要更广泛地传播 bCBTi：许多完成者对治疗有反应，即使只有 3 次治疗也可以显著改善失眠严重程度，bCBTi 可以由新手临床医生提供，并且治疗后医疗保健费用可以降低。失眠仍然是一种治疗不足的疾病，简短的行为治疗可以帮助增加获得护理的机会并减轻失眠的负担。
