Clinical and economic outcomes of remotely delivered Cognitive Behavior Therapy for repeat unscheduled care users with severe health anxiety: A multi-center randomized controlled trial

Abstract

Background: Repeat users of unscheduled health care with severe health anxiety may be challenging to engage in psychological help and incur high service costs. We investigated whether clinical and economic outcomes were improved by offering Remote Cognitive Behaviour Therapy using videoconferencing or telephone (RCBT) compared to Treatment As Usual (TAU). Methods: A single-blind, parallel group, multi-centre randomised controlled trial (RCT) was undertaken in primary and general hospital care. Participants were aged >18 years with >2 unscheduled healthcare contacts within 12 months and clinically severe health anxiety > 18 on the Health Anxiety Inventory (HAI). Data were collected at baseline, 3, 6, 9 and 12 months. The primary outcome was change in HAI from baseline to six months on an intention-totreat basis. Results: 156 (33%) participants were recruited out of 470 who were eligible. 78 were randomised to TAU and 78 to RCBT with data available for 112 participants (72%) at six months. Compared to TAU, RCBT significantly reduced health anxiety at six months (mean change difference HAI - 2.81; 95% CI -5.11, -0.50; p=.017), 9 and 12 months with significant improvements in general health, depression and generalised anxiety. RCBT was strictly dominant with a net monetary benefit of £3,164 per participant at a willingness to pay threshold of £30,000. No treatment-related adverse events were reported in either group. Conclusions: Remotely delivered CBT may reduce health anxiety and cost and may be a promising intervention for repeat users of unscheduled care with severe health anxiety.