Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation

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: Identifier: DRKS00004700.

Commentary: A commentary on this article appears in this issue on page 1767.

Keywords: Internet; cost-benefit; cost-effectiveness; employer perspective; insomnia; randomized controlled trial; self-help.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Absenteeism
  • Adult
  • Cognitive Behavioral Therapy / economics*
  • Cognitive Behavioral Therapy / methods
  • Cost-Benefit Analysis* / methods
  • Female
  • Germany / epidemiology
  • Humans
  • Internet / economics*
  • Male
  • Middle Aged
  • School Teachers
  • Sleep Initiation and Maintenance Disorders / economics*
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Sleep Initiation and Maintenance Disorders / therapy*
  • Waiting Lists