Digital Therapeutic for Chronic Insomnia Linked to Improved Patient Outcomes

Use of a digital therapeutic delivering cognitive behavioral therapy for insomnia (CBT-I) was linked to reduced insomnia severity, emergency department (ED) visits, and net costs for patients with chronic insomnia, according to a real-world cohort study published in ClinicoEconomics and Outcomes Research.

Using claims data from June 1, 2016, to December 31, 2018, the authors of the study measured changes in insomnia severity index (ISI) score and health care resource utilization (HCRU) and costs 2 years following treatment with Somryst, a CBT-I digital therapeutic previously called SHUTi. Patients were either referred to Somryst by their health care provider or accessed it on their own.

These claims data were collected from 248 patients with chronic insomnia. The median age was 56.5 years, and 57.3% were female.

ISI score is categorized as absence of insomnia (0-7), subthreshold insomnia (8-14), moderate insomnia (15-21), or severe insomnia (22-28). In this study, the mean ISI score at baseline was 19.13, with 52.4% of patients being treated with sleep aid medications prior to using Somryst.

The authors found that after 9 weeks of using the digital therapeutic, mean ISI score declined by 37.2%, dropping from 19.13 to 12.0.

Additionally, 58.8% of patients achieved ISI responder status, defined as ISI score improvement of at least 7 points, with a number needed to treat (NNT) of 1.7. Just over a quarter (26.6%) of patients achieved insomnia remission or absence of insomnia, with a NNT for remission of 3.8.

According to the authors, these changes are consistent with those in prior clinical trials and real-world studies.

After 2 years of treatment, the number of ED visits significantly declined by 53% (incidence rate ratio [IRR], 0.47; 95% CI, 0.27-0.82; P = .008). There was also a 21% decrease in hospitalizations (IRR, 0.79; 95% CI, 0.46-1.35; P = .389) and a 13% reduction in hospital outpatient visits (IRR, 0.87; 95% CI, 0.66-1.14; P = .315).

However, the authors found a 2% increase in rates of ambulatory surgical center visits (IRR, 1.02; 95% CI, 0.73-1.44; P = .903) and office visits (IRR, 1.02; 95% CI, 0.92-1.14; P = .672).

Use of the CBT-I therapeutic was also linked to 18.5% decrease in the number of patients receiving sleep aid medications, dropping from 52.4% at baseline to 42.7% post intervention, and the average number of prescriptions decreased from 3.98 to 3.73 (P = .552).

Health care utilization costs also saw a decrease of $2059 per patient, saving a total of $510,678 for all included patients over a 2-year period.

“Given the heavy financial burden that chronic insomnia places on payers, employers, and state and federal health care programs, the clinical improvements and cost reductions demonstrated in these analyses are highly relevant and encouraging,” the authors wrote.

They also said that, with a shortage in licensed clinicians who can deliver CBT-I, delayed access to treatment can potentially increase morbidity in patients who need care.

“During these waiting periods, which can extend for months, insomnia-related comorbidities (eg, depression, anxiety, cardiovascular diseases) may worsen, with subsequent impacts on overall health care costs,” the authors said. “Digital therapeutics (such as the one evaluated in this study), which patients can access as soon as they are identified as needing treatment, can more rapidly reduce morbidity and costly HCRU.”

Regarding limitations of the study, the authors noted that claims data do not contain comprehensive clinical data like insomnia severity or duration. However, they do report some patient experiences while in the health care system, which make them a helpful source of real-world data.

Finally, these results should not be interpreted as causal, as further research is needed on the association between use of the CBT-I digital therapeutic and the measured outcomes.

Reference

Forma F, Knight TG, Thorndike FP, et al. Real-world evaluation of clinical response and long-term healthcare resource utilization patterns following treatment with a digital therapeutic for chronic insomnia. Clinicoecon Outcomes Res. 2022;14:537-546. doi:10.2147/CEOR.S368780