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Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multi-centre randomised controlled trial

Morriss, Richard; Patel, Shireen; Mallins, Sam; Guo, Boliang; Higton, Fred; James, Marilyn; Wu, Mengjun; Brown, Paula; Boycott, Naomi; Kaylor-Hughes, Catherine; Morris, Martin; Rowley, Emma; Simpson, Jayne; Smart, David; Stubley, Michelle; Kai, Joe; Tyrer, Helen


Professor of Psychiatry and Community Mental Health

Sam Mallins

Associate Professor

Fred Higton

Professor of Health Economics

Mengjun Wu

Paula Brown

Naomi Boycott

Catherine Kaylor-Hughes

Martin Morris

Emma Rowley

Jayne Simpson

David Smart

Michelle Stubley

Helen Tyrer


Background: Repeat users of unscheduled health care with severe health anxiety are 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, health anxiety > 18 on the Health Anxiety Inventory (HAI). Randomisation to RCBT or TAU was stratified by site, with allocation conveyed to a trial administrator, research assessors masked to outcome. Data were collected at baseline, 3, 6, 9 and 12 months. Primary outcome was change in HAI from baseline to six months on an intention-to-treat basis. Secondary outcomes were generalised anxiety, depression, physical symptoms, function and overall health. Health economic analysis was conducted from a health service and societal perspective.
Results: 524 patients were referred and assessed for trial eligibility. Of these 470 were eligible and 156 (33%) were recruited; 78 were randomised to TAU and 78 to RCBT. Compared to TAU, RCBT significantly reduced health anxiety at 6 months maintained to 9 and 12 months (mean change difference HAI -2.81; 95% CI -5.11, -0.50; p=0.017) with significant improvements in generalised anxiety, depression and overall health at 12 months but no significant change in physical symptoms or function. RCBT was strictly dominant with a net monetary benefit of £3,164 per participant at willingness to pay threshold of £30,000. No treatment-related adverse events were reported in either group.
Conclusions: RCBT may reduce health anxiety, general anxiety and depression and improve overall health with considerable reductions in health and informal care costs in repeat users of unscheduled care with severe health anxiety who have previously been difficult to engage in psychological treatment. RCBT may be an easy to implement intervention to improve clinical outcome and save costs in one group of repeat users of unscheduled care.


Morriss, R., Patel, S., Mallins, S., Guo, B., Higton, F., James, M., …Tyrer, H. (2019). Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multi-centre randomised controlled trial. BMC Medicine, 17, 1-13.

Journal Article Type Article
Acceptance Date Jan 7, 2019
Online Publication Date Jan 23, 2019
Publication Date Jan 23, 2019
Deposit Date Jan 17, 2019
Publicly Available Date Jan 29, 2019
Journal BMC Medicine
Electronic ISSN 1741-7015
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 17
Article Number 16
Pages 1-13
Keywords Illness anxiety disorder; hypochondriasis; depression; high care costs; urgent care; family care; cognitive behaviour therapy; digital; videoconferencing; remote therapy.
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Additional Information Received: 2 October 2018; Accepted: 7 January 2019; First Online: 23 January 2019; : Ethical approval was obtained from the National Research Ethics Service London – Riverside Committee (reference 14/LO/1102). All participants gave written informed and oral consent to the study, directly to a member of the research team.; : Not applicable.; : The authors declare that they have no competing interests.; : Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.