Cost-effectiveness of telephone cognitive behavioral therapy for osteoarthritis-related insomnia.
Cost-effectiveness of telephone cognitive behavioral therapy for osteoarthritis-related insomnia.
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DOI：
10.1111/jgs.17469
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发表时间：
2022-01
影响因子：
6.3
通讯作者：
Vitiello MV
中科院分区：
文献类型：
--
作者：
Yeung K;Zhu W;McCurry SM;Von Korff M;Wellman R;Morin CM;Vitiello MV
骨关节炎相关失眠是美国老年人中最常见的共病失眠形式。一项随机临床试验发现，六次电话传递的失眠认知行为疗法（CBT-I）改善了这一人群的睡眠结果。利用这些数据，我们从医疗保健行业的角度评估了CBT-I的增量成本效益。这项研究是基于325名患有失眠和骨关节炎疼痛的社区老年人，他们在华盛顿州的Kaiser Permanente登记。我们使用EuroQol五维量表测量了质量调整生命年（Qs）。使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）测量关节炎特异性生活质量。使用失眠严重程度指数（ISI）和无临床失眠的夜晚（即，“无失眠之夜”）。总医疗费用包括干预和医疗利用成本。在随机化后的12个月内，CBT-I分别使ISI和WOMAC改善了-2.6分（95% CI：-2.9至-2.4）和-2.6分（95% CI：-3.4至-1.8）。在12个月内，ISI的改善转化为89个额外的无失眠夜晚（95% CI：79至98）。CBT-I没有显著降低总医疗费用（-1072美元[95% CI：-1968美元至92美元]）。特定条件措施的改善没有反映在QALY收益中（-0.01 [95%CI：-0.01至0.01]）;在每个QALY的支付意愿为150，000美元时，CBT-I产生了369美元的正净货币收益，具有很大的不确定性（95%CI：-1737至2270美元）。CBT-I改善了睡眠和关节炎功能，而不增加成本。这些研究结果支持考虑电话CBT-I治疗患有OA的老年人失眠。我们的研究结果还表明，在评估旨在改善睡眠和关节炎结果的干预措施时，一般生活质量指标存在潜在的局限性。
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.
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影响因子：
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