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

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Title: Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: multicentre, randomised controlled trial
Author(s): Tyrer, P
Tyrer, H
Morris, R
Crawford, MJ
Cooper, S
Yang, M
Guo, B
Mulder, R
Kemp, S
Barrett, B
Item Type: Journal Article
Abstract: Background: Non-cardiac chest pain is very common and generally managed inappropriately. Psychological interventions need more attention. Methods: We tested the effectiveness and cost-effectiveness of a modified form of cognitive behaviour therapy for chest pain (CBT-CP)(4-10 sessions) in patients who attended cardiology clinics or emergency medical services repeatedly. We planned to recruit 96 patients. Participants 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 six and 12 months. The primary outcome was the change in the Health Anxiety Inventory score at six months. Other clinical measures, social functioning, quality of life, and costs of services were also recorded. Findings: 68 patients were randomised with low attrition rates at 6 and 12 months with 81% of all possible assessments completed at 6 and 12 months. Many more patients who were eligible were not referred. The Although there were no significant group differences between any of the outcome measures at either 6 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 (QALY's) in those allocated to CBT-CP compared with standard care (0.76 vs 0.74). Interpretation: It is concluded that CBT-CP in the context of current hospital structures is not a feasible or viable treatment, but is worthy of further research as a potentially cost-effective treatment for non-cardiac chest pain.
Publication Date: 16-May-2017
Date of Acceptance: 9-Jan-2017
ISSN: 2053-3624
Publisher: BMJ Publishing Group
Journal / Book Title: Open Heart
Volume: 4
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 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:
Publication Status: Published
Article Number: e000582
Appears in Collections:Department of Medicine
Faculty of Medicine

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