基于互联网的失眠认知行为疗法：一项健康经济评估。
Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation.
作者信息
Thiart Hanne, Ebert David Daniel, Lehr Dirk, Nobis Stephanie, Buntrock Claudia, Berking Matthias, Smit Filip, Riper Heleen
机构信息
Innovation Incubator, Division of Health Training Online, Leuphana University Lueneburg, Lueneburg, Germany.
Department of Clinical Psychology and Psychotherapy, University Erlangen-Nuremberg, Erlangen, Germany.
出版信息
Sleep. 2016 Oct 1;39(10):1769-1778. doi: 10.5665/sleep.6152.
STUDY OBJECTIVES
Lost productivity caused by insomnia is a common and costly problem for employers. Although evidence for the efficacy of Internet-based cognitive behavioral therapy for insomnia (iCBT-I) already exists, little is known about its economic effects. This study aims to evaluate the cost-effectiveness and cost-benefit of providing iCBT-I to symptomatic employees from the employer's perspective.
METHODS
School teachers (N = 128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a waitlist-control-group, both with access to treatment as usual. Economic data were collected at baseline and 6-mo follow-up. We conducted (1) a cost-effectiveness analysis with treatment response (Reliable Change [decline of 5.01 points] and Insomnia Severity Index < 8 at 6-month follow-up) as the outcome and (2) a cost-benefit analysis. Because both analyses were performed from the employer's perspective, we focused specifically on absenteeism and presenteeism costs. Statistical uncertainty was estimated using bootstrapping.
RESULTS
Assuming intervention costs of €200 ($245), cost-effectiveness analyses showed that at a willingness-to-pay of €0 for each positive treatment response, there is an 87% probability that the intervention is more cost effective than treatment as usual alone. Cost-benefit analyses led to a net benefit of €418 (95% confidence interval: -593.03 to 1,488.70) ($512) per participant and a return on investment of 208% (95% confidence interval: -296.52 to 744.35). The reduction in costs was mainly driven by the effects of the intervention on presenteeism and to a lesser degree by reduced absenteeism.
CONCLUSIONS
Focusing on sleep improvement using iCBT-I may be a cost-effective strategy in occupational health care.
CLINICAL TRIALS REGISTRATION
Title: Online Recovery Training for Better Sleep in Teachers with High Psychological Strain. German Clinical Trial Register (DRKS), URL: https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004700. Identifier: DRKS00004700.
COMMENTARY
A commentary on this article appears in this issue on page 1767.
研究目的
失眠导致的生产力损失对雇主来说是一个常见且成本高昂的问题。尽管基于互联网的失眠认知行为疗法（iCBT - I）的疗效已有证据，但对其经济影响却知之甚少。本研究旨在从雇主的角度评估为有症状的员工提供iCBT - I的成本效益和成本收益。
方法
128名有临床显著失眠症状且存在与工作相关反刍思维的学校教师被随机分为指导性iCBT - I组或等待列表对照组，两组均可获得常规治疗。在基线和6个月随访时收集经济数据。我们进行了（1）以治疗反应（可靠变化[下降5.01分]且6个月随访时失眠严重程度指数<8）为结果的成本效益分析，以及（2）成本收益分析。由于这两项分析均从雇主的角度进行，我们特别关注旷工和出勤主义成本。使用自举法估计统计不确定性。
结果
假设干预成本为200欧元（245美元），成本效益分析表明，对于每个积极的治疗反应，支付意愿为0欧元时，干预措施比单独的常规治疗更具成本效益的概率为87%。成本收益分析得出每位参与者的净收益为418欧元（95%置信区间：-593.03至1,488.70）（512美元），投资回报率为208%（95%置信区间：-296.52至744.35）。成本的降低主要是由干预对出勤主义的影响驱动的，在较小程度上是由旷工减少驱动的。
结论
在职业医疗保健中，使用iCBT - I专注于改善睡眠可能是一种具有成本效益的策略。
临床试验注册
标题：针对心理压力大的教师进行更好睡眠的在线恢复训练。德国临床试验注册中心（DRKS），网址：https://drks - neu.uniklinik - freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004700。标识符：DRKS00004700。
评论
关于本文的一篇评论发表在本期第1767页。
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