A recent mathematical simulation model found that, compared to other insomnia interventions like group cognitive behavioral therapy or pharmacotherapy, digital CBT delivered via Big Health's Sleepio was more cost-effective due to lower expenditures.

The research was funded by Big Health, and conducted by researchers from Johns Hopkins, the University of California, San Francisco, and the digital health company.

Published last month in the journal Sleep, the project built a Markov model simulation of 100,000 individuals and calculated a net monetary benefit of different treatments over a six-month period that took direct and indirect costs of insomnia.

While this approach allowed the researchers to measure the digital CBT app's impact on a large scale, they also warned that the simulation model is built with inherent assumptions (such as its homogenous sample of insomnia patients) and that "future studies should now examine cost-effectiveness using real-world patient data and in different CBT treatment modalities," they wrote.

TOP-LINE DATA

Compared to no insomnia treatment, the model indicated a net monetary benefit of $681.06 per individual receiving Sleepio over six months. This benefit was closely followed by a group CBT intervention ($647.24), then by pharmacotherapy ($273.15). Individual CBT, meanwhile, would increase the cost compared to no treatment by $74.73, according to the model.

Incremental cost-effectiveness ratio (ICER) comparisons between the different interventions painted a similar picture. Here, the model calculated an ICER of −$3,124.73 for the digital CBT app, −$231.81 for group CBT, $9,401.86 for pharmacotherapy and $55,809.80 for individual CBT.

The researchers also conducted a sensitivity analysis to ensure the robustness of their model's results. After randomly varying the digital CBT app's effectiveness and other variables, Sleepio's net monetary benefit remained a positive value in 94.7% of simulations.

HOW IT WAS DONE

The researchers constructed their Markov model using established literature to define parameters involving insomnia remission probability, direct costs of insomnia treatments, indirect costs of insomnia (including excess health expenditure and workplace absenteeism), health-related quality of life and treatment attrition. All of these values assumed a six-month time horizon. Costs were scaled to 2019 dollars, and estimates of health utility were converted into quality-adjusted life years valued at $50,000 per year.

For the sensitivity analysis, the researchers adjusted their assumptions for excess healthcare expenditures, absenteeism, presenteeism and remission probability with the digital CBT app. The simulation was repeated 1,000 times.

THE LARGER TREND

The researchers wrote that their model's results fall in line with prior studies finding both guided digital CBT and clinician-delivered CBT to be cost-effective interventions. Big Health itself also put out a statement highlighting the results and digital CBT's potential to reach a greater number of patients than standard therapies.

“The results of this study demonstrate that [digital] CBT can provide a significant return through lower healthcare expenditures, fewer workplace accidents and better workplace productivity,” Jenna Carl, VP of clinical development and medical affairs at Big Health, said in a statement. “In addition, its ability to provide a destigmatized and automated treatment option at scale makes it attractive for those suffering from poor sleep.”

Of note, Big Health was the initial digital health vendor featured in CVS Caremark's take on a digital health formulary, a decision the pharmacy benefit manager said was based on clinical and cost analyses of the digital treatment. 

The company recently closed a $39 million funding round and highlighted an increase in behavioral health digital therapeutic adoption resulting from the ongoing pandemic. In August, another study backed by the company suggested that the insomnia treatment could also improve users' depressive symptoms.

CONCLUSION

"The cost of treating insomnia with digital CBT was lower than the cost of not treating insomnia (i.e. a do-nothing scenario). Relative to other insomnia treatments, digital CBT was the most cost-effective treatment and reduces indirect societal costs of insomnia-related healthcare utilization and work productivity. Future work should now focus on providing access to and understand the real-world impact of digital CBT for insomnia at a population scale," the researchers concluded.