Abstract 10200: Costs and Resource Utilization of People With Stable Heart Failure and Insomnia: Evidence From a Randomized Trial

Abstract

Introduction: Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBT-I) is efficacious for treating insomnia in the presence of comorbid conditions. This study estimated healthcare costs and resource utilization for people with stable chronic HF and insomnia using data from an NIH-funded clinical trial comparing CBT-I with an HF self-management Methods: Using data from the HeartSleep Study, we examined resource utilization one year following randomization. Resource utilization was measured as self-reported physician office visits, emergency department visits, and inpatient admissions, collected at each follow-up. Costs were estimated by applying price weights to visits, and adding self-reported out of pocket expenses and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and attention control groups. A generalized linear model (GLM) was used to model costs, controlling for covariates. Results: There were no significant differences in demographic characteristics between patients who received CBT-I (N=79) and those who received HF self-management (attention control) (N=71). During the first year following randomization, participants receiving CBT-I had 4.2 inpatient hospitalizations compared to 4.6 for the attention control group (p = 0.40). Participants receiving CBT-I also had 13.1 outpatient visits on average, while control participants had 15.4 outpatient visits. Relatively few emergency department visits were required by either CBT-I or attention-control participants. Overall, total costs were slightly higher for participants who received CBT-I ($7,813 vs. $7,538, p = 0.96). In the multivariable analysis participants who received CBT-I had $630 in higher costs, but this was not statistically different from the attention control group. Conclusions: Among patients with both HF and insomnia, CBT-I and HF self-management had similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to other treatments for insomnia in patients with HF.