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Low-Cost Tele-CBT Increases Insomnia-Free Nights
Cognitive behavioral therapy delivered via teleheath significantly improved sleeplessness and pain without increasing total health care costs in older adults with arthritis-related insomnia, according to study results published in the Journal of the American Geriatrics Society.
“These findings support the consideration of telephone cognitive behavioral therapy for insomnia (CBT-I) for treating insomnia among older adults with comorbid osteoarthritis,” researchers wrote.
The study included 325 community-dwelling adults 60 years and older with moderate to severe insomnia and osteoarthritis pain enrolled through Kaiser Permanente of Washington State. Participants were randomized to either 6 CBT-I sessions delivered by phone over 8 weeks or to coaching and information about sleep and arthritis without CBT-I. Participants rated quality of life, insomnia symptoms, and arthritis pain.
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According to the study, patients in the CBT-I group demonstrated improvements in insomnia and osteoarthritis pain compared with those in the education-only group over the 12 months after randomization. Specifically, arthritis-specific quality-of-life scores decreased an average 2.6 points on the Western Ontario and McMaster Universities Osteoarthritis Index for those in the CBT-I group, while insomnia-specific quality of life scores on the Insomnia Severity Index also deceased an average 2.6 points — which, researchers pointed out, translated to 89 additional insomnia-free nights over the 12 months.
The study estimated the cost to deliver the CBT-I intervention at $194 per person. Total health care costs (intervention costs plus health care utilization costs) did not increase.
“Ignoring potential cost savings of CBT-I and considering only intervention costs, we conservatively estimate that the added cost of gaining an additional insomnia-free night was about $2,” researchers advised.
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