Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis

Abstract

Background Sleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia. Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed. In this study, we assessed the impact of a population-wide rollout of Sleepio in terms of primary care costs in the National Health Service (NHS) in England. Methods The study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. We use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of Sleepio. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes. Results For the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was GBP71,027. This corresponds to GBP6.64 per person in our sample, or around GBP70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescriptions. Conclusion Sleepio rollout reduced primary care costs. National adoption of Sleepio may result in a reduction in primary care costs of GBP20 million in the first year. The expected impact on primary care costs in any particular setting will depend on uptake of Sleepio.

Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials

“…Improving sleep has also been shown to improve aspects of physical health, including fatigue [ 81 ], chronic pain [ 82 , 83 ], and overall health related quality of life [ 84 ] and could reduce the cost of healthcare. For example, offering a digital CBTi intervention (Sleepio) to primary care patients was associated with an average saving of £70.44 per intervention user [ 85 ], and cost savings following sleep intervention have also been specifically reported in people with comorbid mental health difficulties such as depression [ 86 ].…”

Insomnia disorder: State of the science and challenges for the future

“…Recent uncontrolled data evaluating digital CBT‐I in existing healthcare settings in the UK show reductions in insomnia and augmentation of the effects of in‐person therapy for anxiety and depression (Cliffe et al, 2020; Luik et al, 2017; Stott et al, 2021). Importantly, from a health economic perspective, analyses suggest that digital CBT‐I is cost‐effective, and may lead to cost savings if made available at scale (Darden et al, 2021; Sampson et al, 2021). This growing body of evidence behind digital CBT‐I has led to increased recognition of it as a viable and effective treatment option.…”

Quality-adjusted life years for digital cognitive behavioural therapy for insomnia (Sleepio): a secondary analysis

“…Digital delivery is more scalable and appears to be more cost-effective than therapist delivered CBT as it provides similar benefit at a lower cost (16). Sleepio has previously demonstrated cost savings in UK primary care settings, reducing costs by approximately £70.44 per person (12). It is therefore likely to be more cost-effective compared with sleep hygiene advice and face-to-face CBT (estimated by NICE to cost of £542 per person), if priced under £70 per person, as highlighted by NICE in their cost saving recommendation for Sleepio (11).…”

“…This is a concern given that CBT is recommended as the first line treatment for insomnia by the British Association of Psychopharmacology (9), and the American College of Physicians (10). Sleepio, a fully-automated digital CBT (dCBT) based treatment for insomnia, has been recommended by NICE as cost saving (11) by reducing Primary Care costs through fewer GP appointments and sleeping pills prescribed (12). Patients in England usually receive advice about sleep hygiene education (a set of behavioural recommendations to help promote better sleep (13)) or sleeping pills for their insomnia (14,15).…”