Toward cost-effectiveness analysis in the diagnosis and treatment of insomnia

Insomnia is believed to have high prevalence, cost, and impact. However, comprehensive cost-effectiveness analyses (CEAs) of different diagnostic and treatment strategies have not been performed. Part of the reason is that limited data are available on prevalence, costs, and outcomes, each of which is key elements of any CEA. The authors conducted a MEDLINE search to review available literature. Epidemiological surveys have yielded variable results, depending on operational definitions and populations studied. Cost estimates have varied widely depending on whether indirect costs are included and which costs are considered. Impact on health-related quality of life appears to be substantial, but effects on utility scores-necessary to compare cost-effectiveness of insomnia management to that of other health care interventions-have not been reported. Furthermore, much of the data on health-related quality of life is cross-sectional, and cannot be used to test whether the identified associations are causal. The authors conclude that effective insomnia management holds promise as a cost-effective health care intervention. However, the CEA models that eventually may support this hypothesis will require accurate measures of direct and indirect costs, health state utility in treated and untreated insomnia, and prevalence data based on widely-accepted case definitions.