Nurse-Led Cognitive Behavioral Therapy Cost-Effective in COPD
Cognitive behavioral therapy delivered by respiratory nurses can reduce anxiety and is cost-effective in patients with chronic obstructive pulmonary disease (COPD).
Anxiety, an important comorbidity in patients with chronic obstructive pulmonary disease (COPD) that can lead to breathlessness, is associated with high morbidity, disability, healthcare expenditure, and mortality. Mental health professionals have traditionally treated anxiety, but COPD patients often have complex physical health problems and interrelated mental health issues, which can result in barriers to accessing mental health support. A new study published in ERJ Open Research suggests that
For each patient who attended CBT sessions, there was an average savings of £1,089 (US$1395.89) for hospital admissions and £63 (U$S80.75) for emergency department (ED) visits,
From June 2011 to October 2014, the researchers screened 1518 outpatients with COPD using the
Over a 3-month period, patients were either given leaflets on anxiety management (n = 140) or leaflets as well as 30-minute CBT sessions (n = 129) conducted at home or in clinic, 2 to 6 times within 2 weeks. In the CBT sessions, patients were coached on how to develop coping strategies to deal with anxiety caused by breathlessness and to help to improve physical activity levels. All study subjects received standard medical care including lung function testing, appropriate medications, medical review, and pulmonary rehabilitation if appropriate.
After 3 months, patients completed the HADS-Anxiety questionnaire again to assess how the different treatment methods affected anxiety levels. An economic analysis was conducted alongside the trial to evaluate cost-effectiveness of the CBT intervention compared with self-help leaflets. NHS costs (including intervention costs and costs of respiratory-related hospital admissions and ED visits) were compared with Quality Adjusted Life Years (QALYs); all resource use was costed at 2015-2016 prices in Pound Sterling (GBP). Costs of the CBT intervention comprised staff time, including cost of training, delivering the intervention, and ongoing supervision. Both groups received the self-help leaflet so that cost was assumed to be equal.
The study authors conclude that CBT should be incorporated into routine clinical care pathways. “We found that one-to-one CBT sessions delivered by respiratory nurses could reduce symptoms of anxiety and that this could be a cost-effective intervention,” said Heslop-Marshall. Although the CBT intervention initially resulted in added costs, as respiratory nurses required training in CBT skills, this was balanced by the savings associated with fewer hospital and ED visits. Respiratory nurses with dual respiratory and CBT skills can address common comorbid symptoms of anxiety that were previously undertreated.
“Reducing the levels of anxiety patients experience has a significant impact on their quality of life as well as their ability to keep physically active and may improve survival in the long-term,” she said.
Reference
Heslop-Marshall K, Baker C, Carrick-Sen D, et al. Randomised controlled trial of cognitive behavioural therapy in COPD. ERJ Open Res. 2018;4:00094-2018. doi: 10.1183/23120541.00094-2018.
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