Video cognitive‐behavioral therapy for insomnia in cancer patients

Video cognitive‐behavioral therapy for insomnia in cancer patients: A cost‐effective alternative:

Abstract

Objective

Despite its high prevalence, cancer‐related insomnia typically remains untreated because of a lack of access to cognitive‐behavioral therapy for insomnia (CBT‐I), the treatment of choice for this condition. While face‐to‐face CBT‐I appears to be optimal in terms of efficacy, self‐administered formats may be more cost‐effective. The goal of this secondary analysis of a randomized clinical trial was to compare the cost‐effectiveness of a professionally‐based CBT‐I (PCBT‐I) to that of a video‐based CBT‐I (VCBT‐I).

Methods

A total of 161 women with breast cancer received six weekly, individual CBT‐I sessions (PCBT‐I; n = 81) or a 60‐minutes animated video +6 short booklets (VCBT‐I; n = 80). Participants completed the Insomnia Severity Index (ISI) and provided information to calculate treatment costs.

Results

Total per patient treatment costs were 5.5 times greater for PCBT‐I ($1298.90) than VCBT‐I ($234.36; P < .0001). Both at posttreatment and 3‐month follow‐up, the ISI reduction was greater in PCBT‐I than VCBT‐I, but these differences were not significant (P = .09 and P = .24, respectively). In contrast, the cost‐effectiveness ratio was significantly more advantageous for VCBT‐I than PCBT‐I. Compared to VCBT‐I, each reduction of 1 unit on the ISI produced by PCBT‐I was associated with a treatment cost that was significantly greater at posttreatment ($186.95 CAD vs $44.87 CAD; P = .001) and follow‐up ($154.76 vs $24.97, P = .005).

Conclusions

Although CBT‐I is slightly less efficacious when self‐administered, it constitutes a much more cost‐effective alternative than face‐to‐face CBT‐I and represents an extremely valuable option in settings where monetary and human resources required to administer CBT‐I are not available or sufficient.