Cost-effectiveness of cognitive-behavioural therapy for sleep disorder added to usual care in patients with schizophrenia: the BEST study

Background Sleep problems are pervasive in people with schizopnrenia, but there are no clinical guidelines for their treatment. The Better Sleep Trial (BEST) concluded that suitably adapted cognitive behavioural therapy (CBT) is likely to be highly effective, although its cost-effectiveness is unknown. Aims To assess the potential cost-effectiveness of CBT for sleep disorders in patients with schizophrenia. Method An economic evaluation of the BEST study with a 6-month time horizon was used to establish the cost-effectiveness of CBT plus usual care in terms of costs per quality-adjusted life year (QALY) gained. Uncertainty was displayed on cost-effectiveness planes and acceptability curves. Value of information analysis was performed to estimate the aenefits of obtaining further evidence. Results On average, the treatment led to a 0.035 QALY gain (95% CI -0.016 to 0.084), arid 1524 (95% CI-10 529 to 4736) and f1227 (95% CI-10395 to 5361) lower costs from National Health Service and societal perspectives, respectively. The estimated value of collecting more information about the effects of the CBT on costs and QALYs was approximately f87 million. Conclusions CBT for insomnia in people with schizophrenia is effective and potentially cost-effective. A larger trial is needed to provide clear evidence apout its cost-effectiveness.