Journal
OPEN HEART
Volume 4, Issue 1, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/openhrt-2016-000582
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Funding
- Research for Patient Benefit Programme of the National Institute for Health Research [PB-PG-1010-23 192]
- Imperial National Institute for Health Research Biomedical Research Centre
- National Institute for Health Research [PB-PG-1010-23192] Funding Source: researchfish
- National Institutes of Health Research (NIHR) [PB-PG-1010-23192] Funding Source: National Institutes of Health Research (NIHR)
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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.
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