Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: multicentre, randomised controlled trial

Peter Tyrer, Helen Tyrer, Richard Morriss, Mike Crawford, Sylvia Cooper, M. Yang, Boliang Guo, R Mulder, Samuel Kemp, Barbara Michelle Barrett

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Abstract

Objective To investigate the cost-effectiveness of a modified form of cognitive behavioural therapy (CBT) for recurrent non-cardiac chest pain. Methods We tested the effectiveness and costeffectiveness of a modified form of CBT for chest pain (CBT-CP)(4–10 sessions) in patients who attended cardiology clinics or emergency medical services repeatedly. Patients were randomised using a remote webbased system to CBT-CP or to standard care in the clinic. Assessments were made at baseline and at 6 months and 12 months. The primary outcome was the change in the Health Anxiety Inventory Score at 6months. Other clinical measures, social functioning, quality of life and costs of services were also recorded. Results Sixty-eight patients were randomised with low attrition rates at 6 months and 12 months with 81% of all possible assessments completed at 6 months and 12 months. Although there were no significant group differences between any of the outcome measures at either 6 months or 12 months, patients receiving CBT-CP had between two and three times fewer hospital bed days, outpatient appointments, and A&E attendances than those allocated to standard care and total costs per patient were £1496.49 lower, though the differences in costs were not significant. There was a small non-significant gain in quality adjusted life years in those allocated to CBT-CP compared with standard care (0.76 vs 0.74). Conclusions It is concluded that CBT-CP in the context of current hospital structures is not a viable treatment, but is worthy of further research as a potentially cost-effective treatment for non-cardiac chest pain.
Original languageEnglish
JournalOpen Heart
Early online date16 May 2017
DOIs
Publication statusE-pub ahead of print - 16 May 2017

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