Hollenbeak Christopher S, Jeon Sangchoon, O' Connell Meghan, Conley Samantha, Yaggi Henry, Redeker Nancy S
Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA.
School of Nursing, Yale University, West Haven, CT, USA.
Behav Sleep Med. 2024 May-Jun;22(3):263-274. doi: 10.1080/15402002.2023.2241589. Epub 2023 Aug 2.
Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. The purpose of this study was to examine the impact of CBT-I versus HF self-management on healthcare costs and resource utilization among patients with stable chronic HF who participated in a clinical trial of the effects of CBT-I compared to HF self-management education (attention control) over 1 year.
We measured resource utilization as self-reported (medical record review) physician office visits, emergency department visits, and inpatient admissions at 3-month intervals for 1 year after enrollment. Costs were estimated by applying price weights to visits and adding self-reported out-of-pocket and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and the HF self-management group. A generalized linear model (GLM) was used to model costs, controlling for covariates.
The sample included 150 patients [79 CBT-I; 71 self-management (M age = 62 13 years)]. The CBT-I group had 4.2 inpatient hospitalizations vs 4.6 for the self-management group ( = .40). There were 13.1 outpatient visits, in the CBT-I compared with 15.4 outpatient visits (p-value range 0.39-0.81) for the self-management group. Total costs were not significantly different in univariate or ($7,813 CBT-I vs. $7,538 self-management), = .96) or multivariable analyses.
Among patients with both HF and insomnia, CBT-I and HF self-management were associated with similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to usual care and other treatments for insomnia in patients with HF.
近半数慢性心力衰竭（HF）患者报告有失眠症状。本研究旨在探讨与HF自我管理相比，认知行为疗法失眠治疗（CBT-I）对参与一项为期1年的CBT-I与HF自我管理教育（注意力控制）效果临床试验的稳定慢性HF患者医疗成本和资源利用的影响。
我们在入组后1年，以3个月为间隔，通过自我报告（病历审查）测量资源利用情况，包括医生门诊就诊、急诊科就诊和住院情况。通过对就诊应用价格权重并加上自我报告的自付费用和间接费用来估算成本。对CBT-I组和HF自我管理组之间的资源利用和成本进行单变量比较。使用广义线性模型（GLM）对成本进行建模，并控制协变量。
样本包括150名患者[79名接受CBT-I；71名接受自我管理（平均年龄 = 62 ± 13岁）]。CBT-I组有4.2次住院治疗，自我管理组为4.6次（P = 0.40）。CBT-I组有13.1次门诊就诊，自我管理组为15.4次门诊就诊（P值范围为0.39 - 0.81）。单变量分析或多变量分析中，总成本无显著差异（CBT-I组为7813美元，自我管理组为7538美元，P = 0.96）。
在同时患有HF和失眠的患者中，CBT-I和HF自我管理与相似的资源利用和总成本相关。需要进一步研究来评估CBT-I相对于HF患者失眠常规护理和其他治疗的价值。
