title: Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs.
abstract: OBJECTIVE
  To examine health care utilization (HCU) and costs following brief cognitive behavioral treatment for insomnia (bCBTi).
  
  
  METHODS
  Reviewed medical records of 84 outpatients [mean age = 54.25 years (19.08); 58% women] treated in a behavioral sleep medicine clinic (2005-2010) based in an accredited sleep disorders center. Six indicators of HCU and costs were obtained: estimated total and outpatient costs, estimated primary care visits, CPT costs, number of office visits, and number of medications. All patients completed ≥ 1 session of bCBTi. Those who attended ≥ 3 sessions were considered completers (n = 37), and completers with significant sleep improvements were considered responders (n = 32).
  
  
  RESULTS
  For completers and responders, all HCU and cost variables, except number of medications, significantly decreased (ps < 0.05) or trended towards decrease at post-treatment. Completers had average decreases in CPT costs of $200 and estimated total costs of $75. Responders had average decreases in CPT costs of $210. No significant decreases occurred for non-completers.
  
  
  CONCLUSIONS
  bCBTi can reduce HCU and costs. Response to bCBTi resulted in greater reduction of HCU and costs. While limited by small sample size and non-normal data distribution, the findings highlight the need for greater dissemination of bCBTi for several reasons: a high percentage of completers responded to treatment, as few as 3 sessions can result in significant improvements in insomnia severity, bCBTi can be delivered by novice clinicians, and health care costs can reduce following treatment. Insomnia remains an undertreated disorder, and brief behavioral treatments can help to increase access to care and reduce the burden of insomnia.
authors.affiliation: Department of Clinical & Health Psychology, University of Florida, Gainesville, FL.
authors.forename: Christina S
authors.initials: CS
authors.lastname: McCrae
authors.affiliation: VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC) VA Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Bramoweth
authors.affiliation: Department of Clinical & Health Psychology, University of Florida, Gainesville, FL.
authors.forename: Jacob
authors.initials: J
authors.lastname: Williams
authors.affiliation: Department of Clinical & Health Psychology, University of Florida, Gainesville, FL.
authors.forename: Alicia
authors.initials: A
authors.lastname: Roth
authors.affiliation: Department of Psychology, Drexel University, Philadelphia, PA.
authors.forename: Caterina
authors.initials: C
authors.lastname: Mosti
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000191:economics* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Insomnia; brief cognitive behavioral treatment; costs; health care utilization; medication; physician visits