School of Psychology, Université Laval, Quebec City, Quebec, Canada.
CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada.
Psychooncology. 2021 Jan;30(1):44-51. doi: 10.1002/pon.5532. Epub 2020 Sep 9.
Despite its high prevalence, cancer-related insomnia typically remains untreated because of a lack of access to cognitive-behavioral therapy for insomnia (CBT-I), the treatment of choice for this condition. While face-to-face CBT-I appears to be optimal in terms of efficacy, self-administered formats may be more cost-effective. The goal of this secondary analysis of a randomized clinical trial was to compare the cost-effectiveness of a professionally-based CBT-I (PCBT-I) to that of a video-based CBT-I (VCBT-I).
A total of 161 women with breast cancer received six weekly, individual CBT-I sessions (PCBT-I; n = 81) or a 60-minutes animated video +6 short booklets (VCBT-I; n = 80). Participants completed the Insomnia Severity Index (ISI) and provided information to calculate treatment costs.
Total per patient treatment costs were 5.5 times greater for PCBT-I ($1298.90) than VCBT-I ($234.36; P < .0001). Both at posttreatment and 3-month follow-up, the ISI reduction was greater in PCBT-I than VCBT-I, but these differences were not significant (P = .09 and P = .24, respectively). In contrast, the cost-effectiveness ratio was significantly more advantageous for VCBT-I than PCBT-I. Compared to VCBT-I, each reduction of 1 unit on the ISI produced by PCBT-I was associated with a treatment cost that was significantly greater at posttreatment ($186.95 CAD vs $44.87 CAD; P = .001) and follow-up ($154.76 vs $24.97, P = .005).
Although CBT-I is slightly less efficacious when self-administered, it constitutes a much more cost-effective alternative than face-to-face CBT-I and represents an extremely valuable option in settings where monetary and human resources required to administer CBT-I are not available or sufficient.
尽管癌症相关失眠症的患病率很高，但由于无法获得失眠症认知行为疗法（CBT-I），这种疾病的首选治疗方法，因此通常未得到治疗。虽然面对面的 CBT-I 在疗效方面似乎是最佳的，但自我管理的格式可能更具成本效益。这项随机临床试验的二次分析的目标是比较基于专业的 CBT-I（PCBT-I）与基于视频的 CBT-I（VCBT-I）的成本效益。
共有 161 名乳腺癌女性接受了每周 6 次的个体 CBT-I 治疗（PCBT-I；n = 81）或 60 分钟的动画视频+6 本小册子（VCBT-I；n = 80）。参与者完成了失眠严重程度指数（ISI）并提供了计算治疗成本的信息。
PCBT-I 的每位患者治疗费用比 VCBT-I 高 5.5 倍（PCBT-I 为 1298.90 美元，VCBT-I 为 234.36 美元；P < 0.0001）。在治疗后和 3 个月随访时，PCBT-I 组的 ISI 降低幅度均大于 VCBT-I 组，但这些差异无统计学意义（P = 0.09 和 P = 0.24）。相比之下，VCBT-I 的成本效益比明显更有利。与 VCBT-I 相比，PCBT-I 每降低 1 个 ISI 单位，治疗成本在治疗后（186.95 加元与 44.87 加元；P = 0.001）和随访时（154.76 加元与 24.97 加元；P = 0.005）显著更高。
尽管自我管理的 CBT-I 效果略低，但它是一种比面对面的 CBT-I 更具成本效益的替代方法，并且在无法获得或无法提供足够的实施 CBT-I 的金钱和人力资源的环境中，它是一种极具价值的选择。
