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| |  APSS: Cognitive-Behavioral Therapy For Insomnia Reduces Overall Medical Costs W. A. Thomasson Special to DG News
CHICAGO, IL -- June 11, 2001 -- Cognitive-behavioral therapy (CBT) for insomnia, which has been shown to be effective and to have more durable benefits than pharmacologic therapy, significantly reduces the number of medical visits and overall medical costs. This was the conclusion of a study presented today at the annual meeting of the Associated Professional Sleep Societies by Leslie Bourne, PhD, of Fallon Clinic in Worchester, MA, and her associates at Clark University, also in Worchester, and Duke University Medical Center in Durham, NC. In the study, which was said to be the first to report on the effects of insomnia treatment on the utilization of health care, 76 patients received eight group CBT sessions on an outpatient basis. Patients were selected solely on the basis of physician referral. They ranged in age from 16 to 85 years and had a variety of co-morbid conditions. Thus, in contrast to the usual highly selected study groups, Dr. Bourne noted that this was very much a "real-world" patient population. All patients were asked to complete sleep diaries before and during treatment. Their mental states before and immediately following treatment were also assessed using the Brief Symptom Inventory and the Profile of Mood States. Data from these instruments confirmed the efficacy of the intervention. For the 47 patients who completed at least six CBT sessions, Heath Maintenance Organization (HMO) data were used to compare health-provider visits during the six or 12 months before and after the intervention. Six-month results showed that the number of primary-care visits decreased from 2.0 to 1.4, the number of specialist visits from 10.4 to 3.9, and the number of other ambulatory visits from 2.3 to 1.2. Results were less robust at one year, but still achieved statistical significance for reduction in specialty visits and in total ambulatory visits. Dr. Bourne noted that while the reduction in number of visits was almost precisely offset by the number CBT sessions, the CBT sessions were relatively inexpensive, while the medical visits they replaced would have cost much more. When the HMO accountants ran the study data through their cost analysis, they found a significant saving. This saving has led both Fallon Community and other HMOs to offer CBT as a benefit outside the standard psychiatric benefit.
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