Costs and Resource Utilization of People with Stable Heart Failure and Insomnia: Evidence from a Randomized Trial of Cognitive Behavioral Therapy for Insomnia

ABSTRACTObjectives Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. The purpose of this study was to examine the impact of CBT-I versus HF self-management on healthcare costs and resource utilization among patients with stable chronic HF who participated in a clinical trial of the effects of CBT-I compared to HF self-management education (attention control) over 1 year.Methods We measured resource utilization as self-reported (medical record review) physician office visits, emergency department visits, and inpatient admissions at 3-month intervals for 1 year after enrollment. Costs were estimated by applying price weights to visits and adding self-reported out-of-pocket and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and the HF self-management group. A generalized linear model (GLM) was used to model costs, controlling for covariates.Results The sample included 150 patients [79 CBT-I; 71 self-management (M age = 62 + 13 years)]. The CBT-I group had 4.2 inpatient hospitalizations vs 4.6 for the self-management group (p = .40). There were 13.1 outpatient visits, in the CBT-I compared with 15.4 outpatient visits (p-value range 0.39–0.81) for the self-management group. Total costs were not significantly different in univariate or ($7,813 CBT-I vs. $7,538 self-management), p = .96) or multivariable analyses.Conclusions Among patients with both HF and insomnia, CBT-I and HF self-management were associated with similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to usual care and other treatments for insomnia in patients with HF. AcknowledgmentsThe authors thank the following people for their contributions to this study: Andrew Bessette, Stephanie Cram, and Jennifer Hichar. We are also grateful for the support of the Yale's Joint Data Analytics Team.Disclosure statementNo potential conflict of interest was reported by the author(s).Clinical trial informationInsomnia Self-Management in Heart Failure; https://clinicaltrials.gov/ct2/show/NCT02660385; NCT02660385.Statement of significanceTo our knowledge, this study is the first to report the costs and resource utilization for patients with chronic HF and insomnia who received CBT-I and HF self-management. Overall, total resource utilization, including inpatient hospitalizations, emergency department visits, and outpatient office visits were similar, as were direct costs, indirect costs, and total costs over the course of 1 year following randomization. In a multivariable analysis, costs were slightly higher for patients receiving CBT-I, but the difference was not statistically significant. Worsening insomnia was associated with increased costs by approximately 25%, but this effect was also not statistically significant. Additional research is needed with larger samples and with a focus on value determination for strategies to treat insomnia in patients with HF.Additional informationFundingInformation: R01NR016191; P20NR014126; UL1 TR001863