Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
BMC Health Serv Res. 2022 Feb 19;22(1):231. doi: 10.1186/s12913-022-07619-w.
Among the over 5 million informal caregivers for patients with Alzheimer's disease (AD) in the United States (US), over 60% experience insomnia. Research on insomnia treatment efficacy in AD caregivers is limited. An ongoing randomized non-inferiority clinical trial, the Caregiver Sleep Research study, is evaluating whether mindfulness meditation is non-inferior to cognitive behavioral therapy for insomnia (CBT-I) in the treatment of insomnia in AD caregivers. The present report examines estimated intervention costs in this ongoing trial.
Micro-costing was used to itemize and abstract costs of the two interventions: a mindfulness-based intervention known as mindful awareness practices for insomnia (MAP-I); and CBT-I. This approach involves collecting detailed data on resources utilized and the unit costs of those resources, thereby revealing actual resource use and economic costs for each treatment arm. Personnel time, patient time, and supplies were inventoried, and unit costs were applied. Caregiver time costs, including travel, were based on US Labor Bureau home-health aide national mean hourly wages; instructor/staff costs were based on hourly wages. Per-participant and program costs were calculated assuming individual- and group-delivery to reflect real-world implementation. Sensitivity analyses evaluated robustness of estimates.
From the societal perspective, per-participant MAP-I costs were $1884 for individual and $1377 for group delivery; for CBT-I, these costs were $3978 and $1981, respectively. Compared with CBT-I, MAP-I provided cost savings of $2094 (53%) and $604 (30%) per treated caregiver for individual and group delivery, respectively. From the US healthcare system perspective, MAP-I vs. CBT-I participant savings were $1872 (65%) for individual and $382 (44%) for group interventions, respectively. For MAP-I and CBT-I, instructor in-class time was the highest cost component. Results were most sensitive to combined instructor time costs.
Treatment of insomnia with MAP-I, compared to CBT-I, yields substantial cost savings for society and the healthcare system. With this potential for cost savings, results of the ongoing non-inferiority trial have critical implications for insomnia treatment dissemination and its benefits to AD caregivers and other community populations with insomnia.
在美国，超过 500 万的阿尔茨海默病（AD）患者的非正式照顾者中，超过 60%的人患有失眠症。针对 AD 照顾者失眠症治疗效果的研究是有限的。目前正在进行一项随机非劣效性临床试验，即照顾者睡眠研究（Caregiver Sleep Research study），旨在评估正念冥想是否在治疗 AD 照顾者的失眠症方面不劣于认知行为疗法失眠治疗（CBT-I）。本报告探讨了该正在进行的试验中的估计干预成本。
采用微观成本法对两种干预措施的成本进行分项和抽象：一种是基于正念的干预措施，称为正念意识实践治疗失眠（MAP-I）；另一种是 CBT-I。这种方法涉及收集关于所使用资源的详细数据以及这些资源的单位成本，从而揭示每个治疗组的实际资源使用和经济成本。清点人员时间、患者时间和用品，并应用单位成本。照顾者时间成本，包括旅行成本，基于美国劳工局家庭保健助理的全国平均每小时工资；教师/员工成本基于每小时工资。根据个人和小组交付假设计算每位参与者和项目成本，以反映现实世界的实施情况。敏感性分析评估了估计的稳健性。
从社会角度来看，个体 MAP-I 的每位参与者成本为 1884 美元，小组交付成本为 1377 美元；对于 CBT-I，这些成本分别为 3978 美元和 1981 美元。与 CBT-I 相比，个体和小组交付的 MAP-I 分别为每位接受治疗的照顾者节省 2094 美元（53%）和 604 美元（30%）。从美国医疗保健系统的角度来看，MAP-I 与 CBT-I 相比，个体参与者节省 1872 美元（65%），小组干预节省 382 美元（44%）。对于 MAP-I 和 CBT-I，教师课堂时间是最高的成本组成部分。结果对教师综合时间成本最为敏感。
与 CBT-I 相比，使用 MAP-I 治疗失眠症可为社会和医疗保健系统带来可观的成本节约。有了这种节省成本的潜力，正在进行的非劣效性试验的结果对失眠症治疗的传播及其对 AD 照顾者和其他有失眠症的社区人群的益处具有重要意义。
