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Introduction Cost-effectiveness evaluations of psychological interventions, such as internet-delivered cognitive behavioural therapy (iCBT) programmes, in patients with cardiovascular disease (CVD) are rare. We recently reported moderate to large effect sizes on depressive symptoms in CVD outpatients following a 9-week iCBT programme compared with an online discussion forum (ODF), in favour of iCBT. In this paper, we evaluate the cost-effectiveness of this intervention. Methods Cost-effectiveness analysis of a randomised controlled trial. The EQ-5D-3L was used to calculate quality-adjusted life-years (QALYs). Data on healthcare costs were retrieved from healthcare registries. Results At 12-month follow-up, the QALY was significantly higher in iCBT compared with the ODF group (0.713 vs 0.598, p=0.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of 1 year. Incremental cost-effectiveness ratio (ICER) for iCBT versus ODF was €18 865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared with ODF. Conclusions The ICER of €18 865 was lower than the cost-effectiveness threshold range of €23 400–€35 100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective. Trial registration number NCT02778074; Post-results.

Background Ten years ago rheumatoid arthritis (RA) was associated to extensive sick leave during the years after diagnosis despite early instituted disease modifying anti rheumatic drugs (DMARD:s) (1). Since then the treatment strategies have undergone big changes and biological agents have been introduced. Objectives To compare sick leave in early RA today compared to10 years ago. Methods 320 patients were included in the Swedish early RA cohort (TIRA1) during 1996-1998 and 522 patients were included 2005-2008 in the TIRA2 cohort. The prescription of traditional DMARD:s was more frequent in TIRA2 already at inclusion but there were no differences in DAS28 between two cohorts that timepoint. The 120 patients (76% women) that were still participating in TIRA1 at 2-year follow-up and that were ≤ 64 years were included in the present study together with the corresponding 275 patients (74% women) in TIRA2. Sick leave data (sickness benefit and disability pension) were obtained for patients one year before until two years after inclusion (diagnosis). Results One year before diagnosis 20% in TIRA1 and 18% in TIRA2 were on sick leave. Until time for inclusion this number increased to 50% in TIRA1 and 39% in TIRA2. At one year after inclusion much fewer were on sick leave in TIRA2 (30%) than in TIRA-1 (51%). After two years, sick leave in TIRA2 was further reduced to 28% which differs vastly from TIRA1, where the sick leave increased to 54%. The mean days of sickness benefit and disability pension during the year before diagnosis were 42 and 24 respectively in TIRA1 compared to 31 and 35 in TIRA2. During the year after diagnosis, the mean days of sickness benefit and disability pension were 93 and 33 in TIRA1, and 59 and 36 in TIRA2. During the second year the corresponding figures were 72 and 66 days in TIRA 1 versus 35 and 41 days in TIRA2. Conclusions The far lower sick leave rate seen today after a diagnosis of RA, compared to the situation 10 years ago, cannot be explained by differences in sick leave during the year before diagnosis. Although sick leave is lower today, the sick leave rate in TIRA2 is still high compared to the general population. This highlights a need to develop efficient multiprofessional intervention strategies in addition to modern anti-rheumatic pharmacotherapy regimens. References Bjork M, Thyberg I, Rikner K, Balogh I, Gerdle B. (2009). Sick leave before and after diagnosis of rheumatoid arthritis: a report from the Swedish TIRA project. J Rheumatol; 36:1170-1179. Disclosure of Interest None Declared

Objectives to analyse socioeconomic and demographic characteristics at baseline in two cohorts, enrolled 10 years apart and examine possible changes between the cohorts and relate data to contemporary socioeconomic changes in the general population (GP). Methods In 1996-98, 320 patients with early RA (TIRA-1) were recruited from 10 rheumatology units in Sweden and followed over 8 years. A similar cohort was recruited 10 years later and 467 patients (TIRA-2) were enrolled 2006-09. At baseline, patients completed a comprehensive questionnaire with demographic data, marital status, educational level, employment status, EQ-5D and EQ-VAS. Data were compared between the cohorts and comparisons were made with the GP, for men and women separately and for different age groups. Data for GP were derived from Statistics Sweden and EQ-5D values were derived from 2 Swedish population surveys conducted 1999 and 2006. Results In total, 317 patients (99%) in TIRA-1 and 436 (93%) in TIRA-2 completed baseline questionnaires. Patients in the 2006-09 cohort were older, 58 vs 56 years (p=0.050). Gender proportions were similar, 67% women. Women were younger than men, 55 vs 59 in TIRA-1 (p=0.021) and 57 vs 61 in TIRA-2 (p=0.005). Approximately 73% of the patients were living with a partner, in both cohorts and in the GP. In line with increasing formal education in the GP, educational level was higher in TIRA-2 compared to TIRA-1, but was still lower in both cohorts, compared to the GP. Women had higher education than men in both groups. Education was associated to age, younger patients having higher levels of education (p Conclusions Patients in TIRA-2 were older and better educated. Loss of productivity was similar in the cohorts. Sick leave decreased but DP increased. Similar trends were seen in the GP. EQ-5D was significantly lower for RA patients in TIRA-2 compared to TIRA-1 and also compared to the population average, and this was most pronounced in women. Disclosure of Interest None Declared

Background Previous reports from the TIRA cohort have shown that total costs were unchanged during the first 3 years after diagnosis of early rheumatoid arthritis (RA). Ambulatory visits and hospitalization decreased but surgery and drugs increased. Sick leave also decreased, but was offset by early retirement, resulting in unchanged net costs. The present study reflects a period of 6 years after diagnosis, during which there was a paradigm shift, with biological drugs being introduced around year 3. Objectives To calculate direct and indirect costs during 6 years after diagnosis and analyze changes in health care utilization and development of working capacity. Methods One-hundred and twenty-five patients with early (≤1 year) RA, recruited 1996-98, were assessed during 6 years from diagnosis. Clinical and laboratory data were collected and patients were provided with diaries and reported prospectively all health care utilization and number of days lost from work. Annual direct and indirect costs and EQ-5D scores were calculated. Costs were also compared between patients prescribed biologics and non-users. Results Outpatient visits and days in hospitalization decreased during the first 3 years, but costs for surgery and drugs increased. Around year 3, biologics were introduced. Direct costs continued to increase, mainly due to increasing drug costs but also due to increasing surgery and hospitalization. Women had higher costs for surgery, all total joint replacements in hip and knee, except one, were performed in women. During the first 3 years, sick leave decreased, but was offset by a similar increase in disability pensions. Over the following years, sick leave decreased further, but disability pensions increased even more, leading to increasing total indirect costs every year. After initial improvement in EQ-5D, scores slowly deteriorated again. Patients, prescribed biologics, had higher direct costs before prescription, compared to non-users. Apart from surgery, higher costs were maintained after instituting biologics and to some extent, even increased. Conclusions Despite access to biologic drugs, costs continued to increase and drug costs were not offset by reduction in other costs. Effects of biologics must, however, be evaluated over longer time frames, comparing health care utilization and working ability, before and after introduction of biologics. Comparisons with the general population must also be taken into account, since health care utilization differs over time and levels of sick leave and disability pensions are strongly dependent on changing policies and economic conditions in society. Disclosure of Interest None Declared

C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are traditional markers of disease activity in rheumatoid arthritis (RA). Although the two tests show a relatively high degree of correlation and follow the same reaction pattern, the variance of CRP is independent of ESR to some extent.1 Apart from mirroring inflammation, ESR is affected by immunoglobulin levels, sex, and abnormal size or shape of red blood cells.2,3 CRP, which correlates more significantly than ESR with disease activity,1,3,4 is a predictor of functional status/outcome and joint damage in RA.5–7 Although CRP is the better marker of inflammation, ESR adds information reflecting disease severity,4,8 and a combination of the tests may be worthwhile. To create a simple instrument for assessment of disease activity in RA, Prevoo …