Digital cognitive behavioural therapy for insomnia (Sleepio) is associated with gains in quality-adjusted life years.

BACKGROUND: Insomnia is common, and difficulty with daytime functioning is a core symptom. Studies show cognitive behavioural therapy (CBT) improves functioning, but evidence is needed on its value for money. Quality-adjusted life years (QALYs), capturing length and quality of life, provide a standard metric by which to judge whether a treatment is worth its cost. Studies have found QALY gains with therapist-delivered and therapist-guided CBT, but most have not reached statistical significance. Estimates of QALY gains with fully automated digital CBT (dCBT) for insomnia are lacking. AIM: To assess whether dCBT [Sleepio] for insomnia is associated with gains in QALYs compared with a sleep hygiene education control. DESIGN & SETTING: A secondary analysis of a large effectiveness trial of 1,711 participants from the UK, US and Australia. METHOD: EQ-5D scores, NICE's preferred measure of health-related quality of life, were predicted (mapped) from PROMIS-10 Global Health scores and used to determine QALYs from baseline to 24-weeks (controlled), and to 48-weeks (uncontrolled). RESULTS: At week-24, QALYs were significantly higher for the dCBT group (mean QALYs 0.375 and 0.362 in the dCBT and control groups respectively, mean difference=0.014 [95%CI=0.008, 0.019]), and this difference was maintained over the 48-week study period (0.026 [0.016, 0.036]). The difference of 0.026 QALYs is equivalent to 9.5 days in perfect health. CONCLUSION: Sleepio is associated with statistically significant gains in QALYs over time compared with control. Findings may be used to power future studies and inform cost-effectiveness analyses of automated dCBT for insomnia scaled to a population level.Clinical trial registrationEspie et al. 2019 - ISRCTN60530898 http://www.isrctn.com/ISRCTN60530898.