0441 Real-World Healthcare Cost Reductions Following Digital CBT-I for Insomnia: A Matched-Control US Claims Study

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.