BackgroundCognitive‐behavioral therapy for insomnia (CBT‐I) is considered the gold standard treatment for insomnia. Prior trials have delivered CBT‐I across a range of treatment sessions. Understanding the economics of varying treatment approaches is essential for future implementation considerations.MethodsWe conducted a retrospective cost‐effectiveness analysis from the provider's perspective, comparing the implementation of a three‐session CBT‐I program for cancer survivors (CBT‐I‐CS) versus a stepped care treatment approach consisting of an initial single sleep education session followed by CBT‐I‐CS if elevated insomnia symptoms persisted. The effectiveness measure used was the percentage of participants whose insomnia had remitted by the end of each program.ResultsStepped care delivery was more effective than CBT‐I‐CS alone, resulting in 35.4% more remitted patients by the end of the overall program. For a $480 willingness to pay threshold per percentage of remitted patients, stepped care CBT‐I‐CS reached a 98% probability of being cost‐effective, while CBT‐I‐CS alone had only a 2% probability. Larger group sessions in the first step of a stepped care delivery model resulted in more favorable cost‐effectiveness.ConclusionsA stepped care delivery model may be a more cost‐effective approach if it can be implemented efficiently. These findings inform policies aimed at improving cancer survivors' access to much‐needed insomnia treatment in settings where financial resources for CBT‐I may be limited, and be an important barrier to treatment dissemination.Clinical Trial RegistrationThese analyses were not registered.

中文翻译：

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不同认知行为疗法治疗成年癌症幸存者失眠干预方法的回顾性成本效益分析

背景失眠认知行为疗法（CBT-I）被认为是治疗失眠的金标准。之前的试验已经在一系列治疗过程中提供了 CBT-I。了解不同治疗方法的经济学对于未来的实施考虑至关重要。方法我们从提供者的角度进行了回顾性成本效益分析，比较了针对癌症幸存者的三期 CBT-I 计划 (CBT-I-CS) 的实施与阶梯式护理治疗方法，包括最初的单次睡眠教育课程，如果失眠症状持续存在，则进行 CBT-I-CS。使用的有效性衡量标准是在每个项目结束时失眠症得到缓解的参与者的百分比。结果阶梯式护理服务比单独的 CBT-I-CS 更有效，导致在整个项目结束时失眠症缓解的患者数量增加了 35.4%。对于每百分比缓解患者 480 美元的愿意支付门槛，阶梯式护理 CBT-I-CS 达到成本效益的概率为 98%，而单独使用 CBT-I-CS 的概率仅为 2%。阶梯式护理提供模式的第一步中较大的小组会议会带来更有利的成本效益。结论如果能够有效实施，阶梯式护理提供模式可能是一种更具成本效益的方法。这些发现为旨在改善癌症幸存者获得急需的失眠治疗的政策提供了信息，在 CBT-I 的财政资源可能有限的环境中，并且是治疗传播的重要障碍。临床试验注册这些分析未注册。