Insomnia - treatment pathways, costs and quality of life

Abstract

BackgroundInsomnia is perhaps the most common sleep disorder in the general population, and is characterised by a range of complaints around difficulties in initiating and maintaining sleep, together with impaired waking function. There is little quantitative information on treatment pathways, costs and outcomes. The aims of this New Zealand study were to determine from which healthcare practitioners patients with insomnia sought treatment, treatment pathways followed, the net costs of treatment and the quality of life improvements obtained.MethodsThe study was retrospective and prevalence based, and was both cost effectiveness (CEA) and a cost utility (CUA) analysis. Micro costing techniques were used and a societal analytic perspective was adopted. A deterministic decision tree model was used to estimate base case values, and a stochastic version, with Monte Carlo simulation, was used to perform sensitivity analysis. A probability and cost were attached to each event which enabled the costs for the treatment pathways and average treatment cost to be calculated. The inputs to the model were prevalence, event probabilities, resource utilisations, and unit costs. Direct costs and QALYs gained were evaluated.ResultsThe total net benefit of treating a person with insomnia was $482 (the total base case cost of $145 less health costs avoided of $628). When these results were applied to the total at-risk population in New Zealand additional treatment costs incurred were $6.6 million, costs avoided $28.4 million and net benefits were $21.8 million. The incremental net benefit when insomnia was "successfully" treated was $3,072 per QALY gained.ConclusionsThe study has brought to light a number of problems relating to the treatment of insomnia in New Zealand. There is both inadequate access to publicly funded treatment and insufficient publicly available information from which a consumer is able to make an informed decision on the treatment and provider options. This study suggests that successful treatment of insomnia leads to direct cost savings and improved quality of life.

Ethanol Extract of Gardenia augusta (L.) Merr. Flowers Produces Sleep Improvement in Rat Model

“…29,30 Walsh 3 has demonstrated that direct costs for the management of insomnia have been estimated to be USD13.9 billion annually, and successful treatment of insomnia has been indicated to be correlated with direct cost savings and improved quality of life. 31 However, the saving observed from the latter study seemed not so significant, probably due to additional expenses that might arise from the psychoactive nature of most medications for the treatment of sleep disorder. The use of safe and effective plant-derived substances to manage sleep disorder might have additional benefits economically.…”

Specific Quality of Life Measures for Sleep Disorders

“…Moreover, the number of evidence showing the relationship between insomnia and other public health issues such as depression, accidents and anxiety is steadily increasing (Léger & Bayon, 2010;Roth, 2007;Crowley, 2011). Approximately 20% of all motor vehicle accidents are associated with driver sleepiness (independent of alcohol) (Scott, et al, 2011). Sleep apnea, restless leg syndrome, shift work sleep disorders, hypersomnia have also been proved to have an important impact from a socio-economic perspective (Léger & Bayon, 2010;Roth, 2007;Crowley, 2011).…”

“…Patients' family and colleagues could also be negatively affected by insomnia. There are many studies in the medical literature showing that treating sleep disorders increase quality of life (Moyer, et al, 2001;Scott, et al, 2011). Protective measures should be taken in order to underscore the benefits of a good night's sleep and to ensure regular sleep among high-risk individuals.…”

“…Epidemiological studies indicate that sleep-related crashes represent up to 20% of all traffic accidents in industrial societies (Roth, 2007;Smolensky, et al, 2011). The literature suggests that sleeping difficulty doubles the risk of a fatal work-related accident (Scott, et al, 2011). Chronic insomnia has a negative impact on psychological well-being and quality of life.…”

Management of Insomnia in Traditional Persian Medicine

“…Moreover, insomnia goes along with aggravating consequences in daily life, such as fatigue, lack of concentration, irritability, and decline in energy [3]. The reduced quality of sleep has an impact on various physiological and functional conditions [4]. It affects quality of life and the occupational situation of those affected and may therefore require additional health care services [5,6].…”