The Cost-Effectiveness Analysis of Gamiguibi-Tang versus Hwangryunhaedok-Tang for Patients with Insomnia Disorder Based on a Randomized Controlled Trial

Abstract

(1) Insomnia is associated with poor quality of life and loss of productivity, and is a significant economic burden on society. Gamiguibi-tang (GGBT) is the most frequently prescribed herbal medicine for insomnia treatment. Hwangryunhaedok-tang (HHT) is used as an insured herbal medicine for insomnia in the Korean National Health Insurance (NHI) system. This study aims to evaluate the cost-effectiveness of GGBT versus HHT in patients with insomnia disorders based on clinical trial data; (2) Methods: The EuroQol five-dimension scale (EQ-5D) was used to estimate quality-adjusted life-years (QALY). Direct and non-direct medical costs and lost productivity costs were estimated. The cost-effectiveness of GGBT was compared with HHT treatments over six weeks from a societal perspective.; (3) Results: A total of 81 patients who underwent GGBT (n = 56) and HHT (n = 25) treatment completed the clinical trial. The EQ-5D score improved significantly more in the GGBT than in the HHT group (0.02 vs. −0.03, p < 0.05). The QALYs for six weeks were slightly greater in GGBT (0.0997) than in the HHT group (0.0987); however, the total costs incurred were approximately 9% less in GGBT ($ 934) than in the HHT group ($ 1029). GGBT was found to be a more economically dominant treatment option compared to HHT for treating insomnia.; (4) Conclusion: Among herbal medicines, GGBT may be a cost-effective option for treating insomnia from a societal perspective in Korea.

Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review

“…In assessments of insomnia interventions, 16 studies were CUAs [ 35 , 92 – 102 ], one reported a CEA [ 101 ], and another combined a CEA and a cost-benefit analysis [ 96 ]. Economic evaluations were most frequently conducted alongside a randomised controlled trial ( n = 30) [ 35 , 54 , 55 , 57 – 62 , 66 , 82 – 93 , 95 – 97 , 99 – 103 ]. One retrospective case-crossover [ 64 ] and one cohort study [ 63 ] ran economic evaluations concurrently.…”

“…Japan [ 76 , 92 , 104 , 105 ] and Canada [ 68 , 77 , 80 , 101 ] each had four studies, The Netherlands had three studies [ 59 , 95 , 99 ], and Germany [ 96 , 102 ] and France [ 69 , 85 ] had two studies each. Single studies were conducted in Colombia [ 67 ], New Zealand [ 107 ], South Korea [ 103 ], Finland [ 63 ], Australia [ 84 ] and Hong Kong [ 91 ]. Most studies ( n = 28) were conducted in clinical settings, 25 in community settings, and one in a workplace environment.…”

“…Of the 57 studies included (Table 1 ), 32 had one type of QoL apiece: 27 generic [ 53 , 56 , 59 , 63 – 65 , 67 – 69 , 71 , 72 , 74 – 77 , 79 – 81 , 93 , 94 , 97 , 98 , 103 – 105 , 108 , 110 ], four sleep specific [ 84 , 87 , 96 , 101 ], and one depression specific [ 92 ]). Thirteen studies used a combination of one generic and one sleep-specific instrument [ 35 , 54 , 55 , 57 , 58 , 82 , 83 , 85 , 88 , 90 , 95 , 99 , 102 ], nine used two generic instruments each [ 60 – 62 , 66 , 70 , 73 , 78 , 106 , 107 ], two had two sleep-specific instruments [ 89 , 91 ], one utilised one generic and one depression-specific instrument [ 110 ], and one used a combination of a generic, a sleep-specific and osteoarthritis-specific tool [ 100 ].…”

“…Most studies had a mean age of 50 years, but some focussed on distinct age groups: four on those aged 65 years and older [61,62,105,106], one on adolescents aged 12-19 years [95] and one on premature infants [81]. Recruitment strategies varied: in insomnia studies, some involved clinically diagnosed patients, others included those with symptoms but no diagnosis, a few focused on self-referred patients for therapy workshops and one targeted undiagnosed individuals seeking treatment [35,92,93,[96][97][98][99][100][101][102][103][104][105][106][107][108].…”