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

Hanne Thiart, David Daniel Ebert, Dirk Lehr, Stephanie Nobis, Claudia Buntrock, Matthias Berking, Filip Smit, Heleen Riper

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69 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1769-1778
Number of pages10
Issue number10
Publication statusPublished - 1 Oct 2016


  • Internet
  • cost-benefit
  • cost-effectiveness
  • employer perspective
  • insomnia
  • randomized controlled trial
  • self-help

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