ArticleBMJ open2025
Potential benefits of group cognitive-behavioural therapy for insomnia in outpatients with coronary heart disease versus usual care: an early economic evaluation.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveInsomnia afflicts about half of outpatients with coronary heart disease (CHD) and worsens prognosis. We aimed to simulate the potential socioeconomic savings of integrating group cognitive-behavioural therapy for insomnia (gCBT-I) into cardiac outpatient care for patients with CHD compared with usual care.
designEarly health technology assessment using prospective and cross-sectional cohort data.
settingSecondary care for outpatients with CHD in Norway in a non-university hospital setting.
participantsA hypothetical cohort of 100 outpatients with CHD and insomnia.
interventionsWeekly sessions of gCBT-I over 5 weeks versus usual care. PRIMARY AND SECONDARY OUTCOME MEASURES: Potential savings related to possible effects on revascularisations and hospitalisations due to a recurrent CHD event, and reduced sick leave. Representative data on healthcare consumption and sick leave rates were collected from the NORwegian CORonary cohort study (n=528). Costs of productivity loss were drawn from public sources and calculated using a conservative human capital approach. Estimates of therapeutic effectiveness in conveying insomnia remission by gCBT-I were informed by results from randomised trials and meta-analyses.
resultsRates of healthcare consumption and sick leave were higher in outpatients with CHD and insomnia compared with those without insomnia. Our model indicated that treating 100 patients with gCBT-I would cost €2406. If patients treated with gCBT-I show similar rates of revascularisations and hospitalisations as those without insomnia, there is a maximum potential saving of €117,221 per 100 patients tied to healthcare consumption. Similarly, the maximum potential savings related to reduced productivity loss from sick leave range from €53,244 to €692,172.
conclusionTreating insomnia among outpatients with CHD has the potential for substantial reduction of socioeconomic costs related to healthcare consumption and sick leave. Implementation into routine outpatient care seems relevant, but randomised controlled trials investigating the effects of gCBT-I in this population are warranted.
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