Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p><jats:italic>Sleepio</jats:italic> is an automated digital programme that delivers cognitive behavioural therapy for insomnia. <jats:italic>Sleepio</jats:italic> has been proven effective in improving sleep difficulties. However, evidence for the possible impact of <jats:italic>Sleepio</jats:italic> use on health care costs in the United Kingdom has not previously been developed. In this study, we assessed the effect of a population-wide rollout of <jats:italic>Sleepio</jats:italic> in terms of primary care costs in the National Health Service (NHS) in England.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The study was conducted in the Thames Valley region of England, where access to <jats:italic>Sleepio</jats:italic> was made freely available to all residents between October 2018 and January 2020. We use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of <jats:italic>Sleepio</jats:italic>. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>For the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was £71,027. This corresponds to £6.64 per person in our sample or around £70.44 per <jats:italic>Sleepio</jats:italic> user. Secondary analyses suggest that savings may be driven primarily by reductions in prescriptions.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Sleepio rollout reduced primary care costs. National adoption of <jats:italic>Sleepio</jats:italic> may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of <jats:italic>Sleepio</jats:italic>.</jats:p></jats:sec>