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Health care delivery, economics and global health care
Original research article
Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: a multicentre, randomised controlled trial
  1. Peter Tyrer1,
  2. Helen Tyrer1,
  3. Richard Morriss2,
  4. Michael Crawford1,
  5. Sylvia Cooper1,
  6. Min Yang3,
  7. Boliang Guo2,
  8. Roger T Mulder4,
  9. Samuel Kemp5 and
  10. Barbara Barrett6
  1. 1 Centre of Psychiatry, Imperial College London, London, UK
  2. 2 Department of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
  3. 3 School of Public Health, Sichuan University, Chengdu, Sichuan, China
  4. 4 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
  5. 5 Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  6. 6 Kings Health Economics, Kings College, London, UK
  1. Correspondence to Dr Peter Tyrer; p.tyrer{at}imperial.ac.uk

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 cost-effectiveness 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 web-based 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 6 months. 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.

Trial registration number ISRCTN 14711101.

  • non-cardiac chest pain
  • cardiac anxiety
  • cost-effectiveness
  • randomised controlled trial
  • health service use

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/openhrt-2016-000582

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    Footnotes

    • Contributors PT is the chief investigator of the study and has contributed to the design of the study, the study protocol, the generation of sites and preparation of this manuscript. HT is the main supervisor and trainer for CBT-CP who contributed to the design of the study protocol and manuscript preparation. SC developed the recruitment strategy for the study and follow-up procedures and contributed to the design of the study. BB developed the economic evaluation plan and contributed to the design of the study, the study protocol and preparation of this manuscript. RM contributed to the development of the study protocol and participating sites and the preparation of the manuscript. MC contributed to the study protocol, analysis plan and the preparation of this manuscript. MY and BG were involved in developing the statistical analysis plan. The full analysis was performed by BG. RTM contributed to the design of the protocol and was principal investigator for the parallel study in New Zealand. All authors have read and approved the final manuscript.

    • Funding This research was supported by funding from the Research for Patient Benefit Programme of the National Institute for Health Research (reference number PB-PG-1010–23 192). Additional support was provided to the study through the Imperial National Institute for Health Research Biomedical Research Centre.

    • Disclaimer The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the funder.

    • Competing interests None declared.

    • Patient consent Not obtained.

    • Ethics approval NRES (Ethical) Committee East Midlands, Northampton, UK (11/EM/0376).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Full data are available from the principal author and main statistician (BG).