title: Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Focusing on sleep improvement using iCBT-I may be a cost-effective strategy in occupational health care.
  
  
  
  Title: Online Recovery Training for Better Sleep in Teachers with High Psychological Strain. German Clinical Trial Register (DRKS), URL: https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004700. Identifier: DRKS00004700.
  
  
  
  A commentary on this article appears in this issue on page 1767.
authors.affiliation: Innovation Incubator, Division of Health Training Online, Leuphana University Lueneburg, Lueneburg, Germany.
authors.forename: Hanne
authors.initials: H
authors.lastname: Thiart
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: David Daniel
authors.initials: DD
authors.lastname: Ebert
authors.affiliation: Innovation Incubator, Division of Health Training Online, Leuphana University Lueneburg, Lueneburg, Germany.|Leuphana University Lueneburg, Institute of Psychology, Lueneburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Lehr
authors.affiliation: Innovation Incubator, Division of Health Training Online, Leuphana University Lueneburg, Lueneburg, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nobis
authors.affiliation: Innovation Incubator, Division of Health Training Online, Leuphana University Lueneburg, Lueneburg, Germany.|Department of Clinical, Developmental and Neuro Psychology, Section of Clinical Psychology, Vrije Universiteit, EMGO+ Institute for Health and Care Research, VUmc, Amsterdam, The Netherlands.
authors.forename: Claudia
authors.initials: C
authors.lastname: Buntrock
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Berking
authors.affiliation: Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental health and Addiction), Utrecht, The Netherlands.|Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.affiliation: Department of Clinical, Developmental and Neuro Psychology, Section of Clinical Psychology, Vrije Universiteit, EMGO+ Institute for Health and Care Research, VUmc, Amsterdam, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
mesh_terms: D000041:Absenteeism; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis / Q000379:methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D020407:Internet / Q000191:economics*; D008297:Male; D008875:Middle Aged; D000070777:School Teachers; D007319:Sleep Initiation and Maintenance Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D014850:Waiting Lists
keywords: Internet; cost-benefit; cost-effectiveness; employer perspective; insomnia; randomized controlled trial; self-help