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

Peter Tyrer, Helen Tyrer, Richard Morriss, Michael Crawford, Sylvia Cooper, Min Yang, Boliang Guo, Roger T Mulder, Samuel Kemp, Barbara Barrett, Peter Tyrer, Helen Tyrer, Richard Morriss, Michael Crawford, Sylvia Cooper, Min Yang, Boliang Guo, Roger T Mulder, Samuel Kemp, Barbara Barrett

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.

Keywords: cardiac anxiety; cost-effectiveness; health service use; non-cardiac chest pain; randomised controlled trial.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CONSORT diagram. CBT-HA, cognitive behavioural therapy for health anxiety.

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