Cost-effectiveness of telephone cognitive behavioral therapy for osteoarthritis-related insomnia
Osteoarthritis-related insomnia is the most common form of comorbid insomnia among older Americans. A randomized clinical trial found that six sessions of telephone-delivered cognitive behavioral therapy for insomnia (CBT-I) improved sleep outcomes in this population. Using these data, we evaluated...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2022-01, Vol.70 (1), p.188-199 |
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| creator | Yeung, Kai Zhu, Weiwei McCurry, Susan M Von Korff, Michael Wellman, Robert Morin, Charles M Vitiello, Michael V |
| description | Osteoarthritis-related insomnia is the most common form of comorbid insomnia among older Americans. A randomized clinical trial found that six sessions of telephone-delivered cognitive behavioral therapy for insomnia (CBT-I) improved sleep outcomes in this population. Using these data, we evaluated the incremental cost-effectiveness of CBT-I from a healthcare sector perspective.
The study was based on 325 community-dwelling older adults with insomnia and osteoarthritis pain enrolled with Kaiser Permanente of Washington State. We measured quality-adjusted life years (QALYs) using the EuroQol 5-dimension scale. Arthritis-specific quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Insomnia-specific quality of life was measured using the Insomnia Severity Index (ISI) and nights without clinical insomnia (i.e., "insomnia-free nights"). Total healthcare costs included intervention and healthcare utilization costs.
Over the 12 months after randomization, CBT-I improved ISI and WOMAC by -2.6 points (95% CI: -2.9 to -2.4) and -2.6 points (95% CI: -3.4 to -1.8), respectively. The ISI improvement translated into 89 additional insomnia-free nights (95% CI: 79 to 98) over the 12 months. CBT-I did not significantly reduce total healthcare costs (-$1072 [95% CI: -$1968 to $92]). Improvements in condition-specific measures were not reflected in QALYs gained (-0.01 [95% CI: -0.01 to 0.01]); at a willingness-to-pay of $150,000 per QALY, CBT-I resulted in a positive net monetary benefit of $369 with substantial uncertainty (95% CI: -$1737 to $2270).
CBT-I improved sleep and arthritis function without increasing costs. These findings support the consideration of telephone CBT-I for treating insomnia among older adults with comorbid OA. Our findings also suggest potential limitations of the general quality of life measures in assessing interventions designed to improve sleep and arthritis outcomes. |
| doi_str_mv | 10.1111/jgs.17469 |
| format | Article |
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The study was based on 325 community-dwelling older adults with insomnia and osteoarthritis pain enrolled with Kaiser Permanente of Washington State. We measured quality-adjusted life years (QALYs) using the EuroQol 5-dimension scale. Arthritis-specific quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Insomnia-specific quality of life was measured using the Insomnia Severity Index (ISI) and nights without clinical insomnia (i.e., "insomnia-free nights"). Total healthcare costs included intervention and healthcare utilization costs.
Over the 12 months after randomization, CBT-I improved ISI and WOMAC by -2.6 points (95% CI: -2.9 to -2.4) and -2.6 points (95% CI: -3.4 to -1.8), respectively. The ISI improvement translated into 89 additional insomnia-free nights (95% CI: 79 to 98) over the 12 months. CBT-I did not significantly reduce total healthcare costs (-$1072 [95% CI: -$1968 to $92]). Improvements in condition-specific measures were not reflected in QALYs gained (-0.01 [95% CI: -0.01 to 0.01]); at a willingness-to-pay of $150,000 per QALY, CBT-I resulted in a positive net monetary benefit of $369 with substantial uncertainty (95% CI: -$1737 to $2270).
CBT-I improved sleep and arthritis function without increasing costs. These findings support the consideration of telephone CBT-I for treating insomnia among older adults with comorbid OA. Our findings also suggest potential limitations of the general quality of life measures in assessing interventions designed to improve sleep and arthritis outcomes.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.17469</identifier><identifier>PMID: 34633061</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Arthritis ; Behavior modification ; Cognitive ability ; Cognitive behavioral therapy ; Cognitive Behavioral Therapy - economics ; Cognitive Behavioral Therapy - instrumentation ; Cognitive therapy ; Comorbidity ; Cost-Benefit Analysis ; Costs ; Female ; Health care ; Humans ; Insomnia ; Male ; Older people ; Osteoarthritis ; Osteoarthritis - complications ; Osteoarthritis - psychology ; Osteoarthritis - therapy ; Patient Health Questionnaire ; Quality of life ; Quality-Adjusted Life Years ; Single-Blind Method ; Sleep ; Sleep disorders ; Sleep Initiation and Maintenance Disorders - etiology ; Sleep Initiation and Maintenance Disorders - psychology ; Sleep Initiation and Maintenance Disorders - therapy ; Telephone</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2022-01, Vol.70 (1), p.188-199</ispartof><rights>2021 The American Geriatrics Society.</rights><rights>2022 American Geriatrics Society and Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-84b75ce3f4b296a14687ebbb59ec8a7cd3d6e6ff7e40d2f5ddfcfb9025bd47433</citedby><cites>FETCH-LOGICAL-c403t-84b75ce3f4b296a14687ebbb59ec8a7cd3d6e6ff7e40d2f5ddfcfb9025bd47433</cites><orcidid>0000-0002-1102-2040</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34633061$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yeung, Kai</creatorcontrib><creatorcontrib>Zhu, Weiwei</creatorcontrib><creatorcontrib>McCurry, Susan M</creatorcontrib><creatorcontrib>Von Korff, Michael</creatorcontrib><creatorcontrib>Wellman, Robert</creatorcontrib><creatorcontrib>Morin, Charles M</creatorcontrib><creatorcontrib>Vitiello, Michael V</creatorcontrib><title>Cost-effectiveness of telephone cognitive behavioral therapy for osteoarthritis-related insomnia</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Osteoarthritis-related insomnia is the most common form of comorbid insomnia among older Americans. A randomized clinical trial found that six sessions of telephone-delivered cognitive behavioral therapy for insomnia (CBT-I) improved sleep outcomes in this population. Using these data, we evaluated the incremental cost-effectiveness of CBT-I from a healthcare sector perspective.
The study was based on 325 community-dwelling older adults with insomnia and osteoarthritis pain enrolled with Kaiser Permanente of Washington State. We measured quality-adjusted life years (QALYs) using the EuroQol 5-dimension scale. Arthritis-specific quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Insomnia-specific quality of life was measured using the Insomnia Severity Index (ISI) and nights without clinical insomnia (i.e., "insomnia-free nights"). Total healthcare costs included intervention and healthcare utilization costs.
Over the 12 months after randomization, CBT-I improved ISI and WOMAC by -2.6 points (95% CI: -2.9 to -2.4) and -2.6 points (95% CI: -3.4 to -1.8), respectively. The ISI improvement translated into 89 additional insomnia-free nights (95% CI: 79 to 98) over the 12 months. CBT-I did not significantly reduce total healthcare costs (-$1072 [95% CI: -$1968 to $92]). Improvements in condition-specific measures were not reflected in QALYs gained (-0.01 [95% CI: -0.01 to 0.01]); at a willingness-to-pay of $150,000 per QALY, CBT-I resulted in a positive net monetary benefit of $369 with substantial uncertainty (95% CI: -$1737 to $2270).
CBT-I improved sleep and arthritis function without increasing costs. These findings support the consideration of telephone CBT-I for treating insomnia among older adults with comorbid OA. Our findings also suggest potential limitations of the general quality of life measures in assessing interventions designed to improve sleep and arthritis outcomes.</description><subject>Aged</subject><subject>Arthritis</subject><subject>Behavior modification</subject><subject>Cognitive ability</subject><subject>Cognitive behavioral therapy</subject><subject>Cognitive Behavioral Therapy - economics</subject><subject>Cognitive Behavioral Therapy - instrumentation</subject><subject>Cognitive therapy</subject><subject>Comorbidity</subject><subject>Cost-Benefit Analysis</subject><subject>Costs</subject><subject>Female</subject><subject>Health care</subject><subject>Humans</subject><subject>Insomnia</subject><subject>Male</subject><subject>Older people</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis - complications</subject><subject>Osteoarthritis - psychology</subject><subject>Osteoarthritis - therapy</subject><subject>Patient Health Questionnaire</subject><subject>Quality of life</subject><subject>Quality-Adjusted Life Years</subject><subject>Single-Blind Method</subject><subject>Sleep</subject><subject>Sleep disorders</subject><subject>Sleep Initiation and Maintenance Disorders - etiology</subject><subject>Sleep Initiation and Maintenance Disorders - psychology</subject><subject>Sleep Initiation and Maintenance Disorders - therapy</subject><subject>Telephone</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtvFDEQhC1ERJbAgT-ARuIChwl-23NBilY8IkXKBc7G42nveDVrL7Z3pfx7vCREkL70ob4uVasQekPwJWnzcbspl0RxOTxDKyIY7QUn4jlaYYxpryXh5-hlKVuMCcVav0DnjEvGsCQr9HOdSu3Be3A1HCFCKV3yXYUF9nOK0Lm0ieEkdSPM9hhStktXZ8h2f9f5lLt2D8nmOueGlT7DYitMXYgl7WKwr9CZt0uB1w_7Av348vn7-lt_c_v1en110zuOWe01H5VwwDwf6SAt4VIrGMdRDOC0VW5ikwTpvQKOJ-rFNHnnxwFTMU5cccYu0Kd73_1h3MHkINaW1Oxz2Nl8Z5IN5n8lhtls0tFoxalSohm8fzDI6dcBSjW7UBwsi42QDsVQofHAsRS4oe-eoNt0yLG9Z6gkSlFN9Yn6cE-5nErJ4B_DEGxOvZnWm_nTW2Pf_pv-kfxbFPsN8yaXFA</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Yeung, Kai</creator><creator>Zhu, Weiwei</creator><creator>McCurry, Susan M</creator><creator>Von Korff, Michael</creator><creator>Wellman, Robert</creator><creator>Morin, Charles M</creator><creator>Vitiello, Michael V</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1102-2040</orcidid></search><sort><creationdate>20220101</creationdate><title>Cost-effectiveness of telephone cognitive behavioral therapy for osteoarthritis-related insomnia</title><author>Yeung, Kai ; Zhu, Weiwei ; McCurry, Susan M ; Von Korff, Michael ; Wellman, Robert ; Morin, Charles M ; Vitiello, Michael V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-84b75ce3f4b296a14687ebbb59ec8a7cd3d6e6ff7e40d2f5ddfcfb9025bd47433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Arthritis</topic><topic>Behavior modification</topic><topic>Cognitive ability</topic><topic>Cognitive behavioral therapy</topic><topic>Cognitive Behavioral Therapy - economics</topic><topic>Cognitive Behavioral Therapy - instrumentation</topic><topic>Cognitive therapy</topic><topic>Comorbidity</topic><topic>Cost-Benefit Analysis</topic><topic>Costs</topic><topic>Female</topic><topic>Health care</topic><topic>Humans</topic><topic>Insomnia</topic><topic>Male</topic><topic>Older people</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis - complications</topic><topic>Osteoarthritis - psychology</topic><topic>Osteoarthritis - therapy</topic><topic>Patient Health Questionnaire</topic><topic>Quality of life</topic><topic>Quality-Adjusted Life Years</topic><topic>Single-Blind Method</topic><topic>Sleep</topic><topic>Sleep disorders</topic><topic>Sleep Initiation and Maintenance Disorders - etiology</topic><topic>Sleep Initiation and Maintenance Disorders - psychology</topic><topic>Sleep Initiation and Maintenance Disorders - therapy</topic><topic>Telephone</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yeung, Kai</creatorcontrib><creatorcontrib>Zhu, Weiwei</creatorcontrib><creatorcontrib>McCurry, Susan M</creatorcontrib><creatorcontrib>Von Korff, Michael</creatorcontrib><creatorcontrib>Wellman, Robert</creatorcontrib><creatorcontrib>Morin, Charles M</creatorcontrib><creatorcontrib>Vitiello, Michael V</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yeung, Kai</au><au>Zhu, Weiwei</au><au>McCurry, Susan M</au><au>Von Korff, Michael</au><au>Wellman, Robert</au><au>Morin, Charles M</au><au>Vitiello, Michael V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness of telephone cognitive behavioral therapy for osteoarthritis-related insomnia</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2022-01-01</date><risdate>2022</risdate><volume>70</volume><issue>1</issue><spage>188</spage><epage>199</epage><pages>188-199</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract>Osteoarthritis-related insomnia is the most common form of comorbid insomnia among older Americans. A randomized clinical trial found that six sessions of telephone-delivered cognitive behavioral therapy for insomnia (CBT-I) improved sleep outcomes in this population. Using these data, we evaluated the incremental cost-effectiveness of CBT-I from a healthcare sector perspective.
The study was based on 325 community-dwelling older adults with insomnia and osteoarthritis pain enrolled with Kaiser Permanente of Washington State. We measured quality-adjusted life years (QALYs) using the EuroQol 5-dimension scale. Arthritis-specific quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Insomnia-specific quality of life was measured using the Insomnia Severity Index (ISI) and nights without clinical insomnia (i.e., "insomnia-free nights"). Total healthcare costs included intervention and healthcare utilization costs.
Over the 12 months after randomization, CBT-I improved ISI and WOMAC by -2.6 points (95% CI: -2.9 to -2.4) and -2.6 points (95% CI: -3.4 to -1.8), respectively. The ISI improvement translated into 89 additional insomnia-free nights (95% CI: 79 to 98) over the 12 months. CBT-I did not significantly reduce total healthcare costs (-$1072 [95% CI: -$1968 to $92]). Improvements in condition-specific measures were not reflected in QALYs gained (-0.01 [95% CI: -0.01 to 0.01]); at a willingness-to-pay of $150,000 per QALY, CBT-I resulted in a positive net monetary benefit of $369 with substantial uncertainty (95% CI: -$1737 to $2270).
CBT-I improved sleep and arthritis function without increasing costs. These findings support the consideration of telephone CBT-I for treating insomnia among older adults with comorbid OA. Our findings also suggest potential limitations of the general quality of life measures in assessing interventions designed to improve sleep and arthritis outcomes.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34633061</pmid><doi>10.1111/jgs.17469</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-1102-2040</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Arthritis Behavior modification Cognitive ability Cognitive behavioral therapy Cognitive Behavioral Therapy - economics Cognitive Behavioral Therapy - instrumentation Cognitive therapy Comorbidity Cost-Benefit Analysis Costs Female Health care Humans Insomnia Male Older people Osteoarthritis Osteoarthritis - complications Osteoarthritis - psychology Osteoarthritis - therapy Patient Health Questionnaire Quality of life Quality-Adjusted Life Years Single-Blind Method Sleep Sleep disorders Sleep Initiation and Maintenance Disorders - etiology Sleep Initiation and Maintenance Disorders - psychology Sleep Initiation and Maintenance Disorders - therapy Telephone |
| title | Cost-effectiveness of telephone cognitive behavioral therapy for osteoarthritis-related insomnia |
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