While the benefits of a good night’s sleep can be priceless, and sleeplessness imposes significant costs on the individual and society, little is known about the financial impact of treatment for sleep-related disorders. Sleep researchers at the University of Maryland School of Medicine conducted a review of insomnia treatment cost-effectiveness and found financial estimates of untreated sleeplessness in the United States topping $100 billion a year and studies documenting substantial healthcare cost savings when insomnia is treated, recouping treatment costs within 6 to 12 months. Their analysis was published recently in the journal Sleep Medicine Reviews.
Roughly one out of five adults in the United States has difficulty falling asleep or staying asleep, according to the review’s lead author, Emerson M. Wickwire, PhD. “Insomnia is the most widespread clinical sleep disorder among adults. Sleep for some people is a lot like a slippery fish. The more you try to grab at it, the more it jumps out of your hands,” says Wickwire, an assistant professor of psychiatry and medicine at the University of Maryland School of Medicine and director of the Insomnia Program at the University of Maryland Medical Center, in a release.
The review found that the estimated financial costs of insomnia range from $28.1 billion to $216.6 billion. Wickwire and his team note that newer studies tend to report more comprehensive—and thus higher—estimates.
The review found that much of insomnia’s economic toll is based on indirect costs: poorer workplace performance, higher healthcare utilization, and increased accident risk. More recent studies have focused on the impact of insomnia on health-related quality of life—its effect on a person’s physical, emotional, and social life, as well as overall happiness. The review found that people with insomnia consistently report lower quality of life scores compared to their non-insomniac peers.
Wickwire says highly effective drug-based and behavioral therapies for insomnia exist, but the majority of people with insomnia never receive treatment. “People don’t seek care in part because they’re uncomfortable acknowledging it’s a problem, or they don’t realize it’s a problem or that effective treatments are available. And, of course, there’s a gross lack of awareness among healthcare providers as well,” he says.
Wickwire says another key barrier is limited access to care: “Payors such as health insurers have historically underfunded insomnia treatment, in part because they have not been sure what the payoff is.”
The researchers reviewed 10 studies of the cost-effectiveness of both pharmacological and behavioral treatments. The review found that both medication and behavioral interventions were more than worth the money.
Wickwire says that treatment likely reduces overall healthcare use related to insomnia.
The authors suggest that insomnia researchers should measure direct and indirect insomnia-related costs in all their studies, including measures of workplace productivity and healthcare quality of life.
“Cost-effectiveness is a key part of current healthcare research,” says E. Albert Reece, MD, PhD, MBA, vice president for medical affairs at the University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine. “This timely review presents information that may help policymakers determine the most effective, most efficient ways to improve the quality of sleep, which is a fundamental health requirement.”