To investigate cost-effectiveness of adolescent cognitive behavioral therapy for insomnia (CBTI) in
group- and Internet-delivered formats, from a societal perspective with a time horizon of 1 y
and effects data up to 1-y follow-up were obtained from a randomized controlled trial (RCT) comparing Internet CBTI to face-to-face
group CBTI. The study was conducted at the laboratory of the Research Institute of Child Development and Education at the
University of Amsterdam, and the academic youth mental health care center UvAMinds in Amsterdam. Sixty-two participants meeting
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for insomnia were randomized
to face-to-face group CBTI (GT; n = 31, age = 15.6 y ± 1.8, 71.0% girls) or individual Internet CBTI (IT; n = 31, age = 15.4
y ± 1.5, 83.9% girls). The intervention consisted of six weekly sessions and a 2-mo follow up booster-session of CBTI, consisting
of psychoeducation, sleep hygiene, restriction of time in bed, stimulus control, cognitive therapy, and relaxation techniques.
GT sessions were held in groups of six to eight adolescents guided by two trained sleep therapists. IT consisted of individual
Internet therapy with preprogrammed content similar to GT, and guided by trained sleep therapists.
measures were subjective sleep efficiency (SE) ≥ 85%, and quality-adjusted life-years (QALY). Analyses were conducted from
a societal perspective. Incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling, and presented
in cost-effectiveness planes. Primary analysis showed costs over 1 y were higher for GT but effects were similar for IT and
GT. Bootstrapped ICERs demonstrated there is a high probability of IT being cost-effective compared to GT. Secondary analyses
confirmed robustness of results.
Internet CBTI is a cost-effective treatment compared to group CBTI
for adolescents, although effects were largely similar for both formats. Further studies in a clinical setting are warranted.