J.A. Martikainen

Neuropsychiatric symptoms and Quality of Life in patients with very mild and mild Alzheimer's disease

Neuropsychiatric symptoms (NPS) are common manifestations of Alzheimers disease (AD).

Decreasing sense of coherence and its determinants in spousal caregivers of persons with mild Alzheimer's disease in three year follow-up: ALSOVA study.

BACKGROUNDnSense of coherence (SOC) is associated with the capability to cope with caregiving. Our aims were (1) to describe the trajectory of SOC in aged spousal caregivers of persons with mild Alzheimers disease (AD) in 3-year follow-up and (2) to identify baseline determinants influencing SOC change.nnnMETHODSnBoth AD (n = 170) (CDR-SOB, MMSE, NPI, ADCS-ADL) and caregiver- (n = 170) (BDI, SOC) related efficacy parameters were evaluated annually. Follow-up time was 3 years. The relationship of potential baseline factors with longitudinal SOC was analyzed using linear mixed models.nnnRESULTSnThe mean drop-out-adjusted SOC score (148.5 at baseline) was decreased by 4.56 points (p = 0.002) during the follow-up. Caregivers depression at baseline predicted the significant decrease of SOC (every + 1 BDI point decreases 2.181 points in SOC, p = 0.0001). When caregivers depression was not taken into account in the analysis, female gender, and higher age and AD patients lower baseline MMSE were associated significantly (p < 0.05) with decreasing SOC score in the follow-up. Other studied covariates were not associated with SOC change.nnnCONCLUSIONSnSOC is not as stable as expected, but decreases during long-lasting caregiving. Caregivers depression at baseline predicts SOC decrease over time. In the future, caregiver dependent factors should be evaluated at the beginning of caregiving to target individualized support programmes to the vulnerable caregivers.

Validation of A Markov Model for Economic Evaluation of Screening and Preventive Interventions In Alzheimer's Disease In Denmark.

uf076 The Markov states are presented in Figure 1. Each stage of AD could either be ‘detected’, or ‘not detected’ to reflect the difference in effectiveness and costs of interventions. uf076 The model accurately simulates Alzheimers disease progression. uf076 The model provides a simple and robust framework for economic evaluation of screening and other nonpharmaceutical interventions for AD. uf076 Further expansion of the model should incorporate comparisons of interventions in terms of incremental cost-effectiveness.

SAT0154 A 6-Month Induction Treatment with Infliximab Added on Intensive Combination Therapy with Conventional Dmards and Low-Dose Prednisolone Saves Work Productivity Loss During the First Treatment Year in Patients with Early Rheumatoid Arthritis: Table 1

Background Loss of work productivity has been the most expensive consequence of rheumatoid arthritis but more effective drug treatments have in recent years resulted in savings in productivity costs. Objectives In this study we estimated the capacity of the induction treatment with infliximab added on an already intensive combination treatment with conventional antirheumatic drugs to result in further savings in costs of absenteeism (ABS) and presenteeism (PRES). Methods 99 patients with active early RA were enrolled into an investigator-initiated, randomized, double-blind, trial, the NEO-RACo trial. They were treated with an intensified combination (FR) of MTX, SASP, HCQ, low-dose prednisolone, and intra-articular glucocorticoid (GC) injections for 2 years. In addition, they were randomized to receive an added-on induction treatment with either infliximab (FR+INFL group) or placebo (FR+Pla group) infusions for the initial 6 months. Patients were assessed clinically 11 times during the first 12 months and thereafter every 3 months. At all times, treatment was targeted to a modified strict ACR remission with increase of drug doses or switch between DMARDs, as well as GC injections into swollen joints, if RA was active. Data about RA-related lost workdays (ABS) were gathered, as well as about self-reported PRES with VAS. The monetary value of lost productivity was estimated by the human capital method based on the mean earnings of all employees obtained from Statistics Finland and added by supplementary social welfare expenses: men 4656 EUR and women 3868 EUR per month, respectively. Results Table 1 shows the amount of estimated work productivity loss by PRES and ABS during the follow-up. Table 1 Time period PRES ABS Total FR+Pla FR+INFL FR+Pla FR+INFL FR+Pla FR+INFL 1st year 6.99% 7.42% 23.59% 12.41%* 30.95% 20.35%** 2nd year 1.34% 1.72% 12.41% 7.53% 13.55% 9.56%* p=0.035,** p=0.041, both adjusted for sex and age. The total loss of productivity per patient amounted in the 1st year 15 669 EUR and in the 2nd 7 011 EUR in FR+Pla. In FR+INFL, the respective sums were 10 225 and 4 791 EUR. The ratio of lost productivity between groups was 1.54 (95% CI: 1.02 to 2.21) in the 1st year and 1.52 (0.51 to 3.03 in the 2nd year; adjusted for age, sex, rheumatoid factor, duration of symptoms, as well as baseline DAS28 and physicians global assessment (PhGA). The ratio between ABS and PRES was 2.56 (95% CI: 1.53 to 3.59) in the 1st and 6.46 (1.74 to 11.17) in the 2nd year. The baseline variables (sex, age, DAS28, rheumatoid factor, duration of symptoms, PhGA, symptoms of depression, vitality, and BMI) were tested as predictors of the 1st year ABS and PRES. PhGA, vitality, and BMI entered into the forward stepwise regression model for PRES. Regarding ABS only PhGA entered into the model. Conclusions Despite an intensive treatment with three conventional DMARDs, low-dose prednisolone, and intra-articular GC injections an added-on 6-month induction treatment with INFL resulted in savings in costs of ABS during the 1st treatment year but not later. Significant influence on PRES was not shown. Disclosure of Interest None declared

OP0065 Initial Infliximab is not Cost-Effective in Otherwise Actively Treated Early Rheumatoid Arthritis. the 2-Year Follow-Up Results of the Randomized Clinical Neo-Raco Trial

Background In most early rheumatoid arthritis (RA) patients, early remission and a non-progressive state of disease can be achieved when an initial treatment with a triple combination of disease modifying antirheumatic drugs (DMARDs) and on-demand intraarticular glucocorticoids (ia GCs) is used. However, adding infliximab for the first six months to this treatment halts the otherwise marginal radiographic progression totally and decreases the number of ia GCs needed [1]. Objectives To study, with various clinical outcomes, the cost-effectiveness of adding initial infliximab to a remission-targeted combination treatment with DMARDs in early RA. Methods During the first 2 years, the resource use of all RA-related visits, medications, and ia GCs were collected from the 99 patients with early, DMARD-naïve RA, who, within the NEO-RACo trial, were treated with the triple combination of DMARDs (methotrexate, sulphasalazine, hydroxychloriquine) and prednisolone, and who were randomized to double-blindly receive either infliximab (FIN-RACo+INFL) or placebo (FIN-RACo+PLA) infusions during the first 6 months. The treatment goal was strict remission in all patients; pre-defined treatment modifications and ia GCs were applied in active disease. The unit costs of the utilized resources were obtained from the national list of health care unit costs and other published sources. The incremental costs (ICER) for achieving an additional remission or for having radiographic non-progression at 2 years were assessed. Remission was defined by the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean criteria [2], as well as by the very strict FIN-RACo criteria, which allowed no tender or swollen joints [1]. Radiographic non-progression was defined as nil change in the modified Sharp van der Heijde score from baseline to 2 years. Results The total mean costs of treatment for 2 years were €15,347 for the patients in the FIN-RACo+INFL group and €5,481 for the FIN-RACo+PLA group patients (ratio 2.80, 95% CI: 2.34 to 3.13). The Boolean ACR/EULAR remission was achieved at 2 years by 68% and 63%, the strict FIN-RACo remission by 66% and 53%, and absolute radiographic non-progression by 80% and 53% of these patients, respectively. The 2-year ICER per one additional patient achieving these outcomes by adding infliximab on the FIN-RACo strategy for the first 6 months were €208,577, €76,249, and €36,404, respectively. Conclusions Regardless of the clinical outcome assessed, in early RA, adding a six-month course of infliximab into a targeted treatment with combination DMARDs and prednisolone cannot be considered cost-effective. References Leirisalo-Repo M et al. Ann Rheum Dis 2013;72:851-7. Felson DT et al. Arthritis Rheum 2011;63:573-86. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3265