Abstract Introduction Insomnia affects one-third of US adults and carries substantial economic burden. Despite guideline recommendations for cognitive behavioral therapy for insomnia (CBT-I) as first-line treatment, access is constrained by shortage of trained clinicians. Fully automated digital CBT-I offers a scalable alternative with potential to reduce population-level healthcare costs, yet large-scale US economic evidence remains limited. Methods Retrospective cohort study comparing healthcare costs (2013-2023) for 11, 027 adults initiating SleepioRx versus 10, 770 matched controls receiving standard insomnia care. Participants matched 1: 1 on age, sex, insurance type, geography, baseline comorbidities, and index year. Primary outcome: difference-in-differences in total annual healthcare costs (medical + pharmacy) for 12 months pre-initiation and post-initiation. Analyses used ordinary least squares regression with sensitivity adjustments for baseline utilization and comorbidities. Costs standardized to 2023 US dollars. Results Final sample: 21, 797 adults (mean age 44 years; 66% female). Patients initiating digital CBT-I demonstrated substantially greater cost reductions than matched controls over one year. Mean savings: 2, 083 per person annually (95% CI 1, 443-2, 722; P. 001), representing 40% reduction in total costs relative to usual care. Pharmacy costs drove the majority of savings (1, 745 per person-year; 46% reduction), with smaller favorable changes in medical service costs. Conclusion In a large real-world US claims analysis, digital CBT-I initiation was associated with marked healthcare cost reductions compared with standard insomnia management. These findings support scaling digital CBT-I within commercial and Medicare populations as a high-value strategy for addressing both clinical need and economic burden of insomnia. Support (if any) This analysis was supported by Big Health and the Office of Health Economics.
Miller et al. (Fri,) studied this question.
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