The Cost of Insomnia and the Benefit of Increased Access to Evidence-Based Treatment Cognitive Behavioral Therapy for Insomnia

The recognition of insomnia as a separate comorbid condition rather than a secondary condition of mood and anxiety disorders and other health problems points to the need for a durable treatment rather than temporary symptomatic relief. Insomnia medications are most suitable for alleviation of transient sleep disturbances in people who otherwise have a low degree of dysfunctional sleep-related thoughts and behaviors. Based on current data available, CBT-I is more effective, safer, and more cost-effective than pharmacotherapy or nontreatment of insomnia. Despite this, and recommendations from multiple national and international institutions for CBT-I as first-line therapy, nontreatment and pharmacotherapy continue to be the predominant treatment approach for insomnia sufferers. The main reasons for this are lack of awareness of CBT-I and lack of treatment providers. A more comprehensive cost-effectiveness analysis on insomnia treatment can be expected to demonstrate that CBT-I is less expensive than pharmacologic treatment. This is because of a reduction in indirect and long-term costs of insomnia. Several therapy sessions of CBT-I are probably not more expensive than pharmacotherapy (based on our rough calculations). However, self-administered, group, and stepped care models of CBT-I are being developed and evaluated as a means to make this intervention have a lower direct cost, and more critically, available to meet the needs of the population. A large initial investment would expedite the availability of evidence-based programs. The stakeholders, aside from the sufferers themselves, who stand to reap the most financial benefit from improved treatment of insomnia are employers and health insurance companies. Growing evidence of the superiority of CBT-I over nontreatment and pharmacotherapy with regard to recovery of the financial losses associated with indirect costs of lost productivity, absenteeism, and increased health care utilization because of comorbidities and injuries can help influence key stakeholders.