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ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk.MethodsA population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment.Results996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR 1.05; 95% CI 0.75 to 1.48). Participants who received tCBT were more likely to report better quality of life (EQ-5D-5L utility score mean difference 0.024 (95% CI 0.009 to 0.040)); and had 0.023 (95% CI 0.007 to 0.039) more quality-adjusted life-years at an additional cost of £42.30 (95% CI −£451.19 to £597.90), yielding an incremental cost-effectiveness ratio of £1828. Most secondary outcomes showed significant benefit for the intervention.ConclusionsA short course of tCBT did not prevent onset of CWP in adults at high risk, but improved quality of life and was cost-effective. A low-cost, short-duration intervention benefits persons at risk of CWP.Trial registration numberClinicalTrials.gov Registry (NCT02668003).

Aims To assess the cost-effectiveness of an improved automated grading algorithm for diabetic retinopathy against a previously described algorithm, and in comparison with manual grading. Methods Efficacy of the alternative algorithms was assessed using a reference graded set of images from three screening centres in Scotland (1253 cases with observable/referable retinopathy and 6333 individuals with mild or no retinopathy). Screening outcomes and grading and diagnosis costs were modelled for a cohort of 180 000 people, with prevalence of referable retinopathy at 4%. Algorithm (b), which combines image quality assessment with detection algorithms for microaneurysms (MA), blot haemorrhages and exudates, was compared with a simpler algorithm (a) (using image quality assessment and MA/dot haemorrhage (DH) detection), and the current practice of manual grading. Results Compared with algorithm (a), algorithm (b) would identify an additional 113 cases of referable retinopathy for an incremental cost of £68 per additional case. Compared with manual grading, automated grading would be expected to identify between 54 and 123 fewer referable cases, for a grading cost saving between £3834 and £1727 per case missed. Extrapolation modelling over a 20-year time horizon suggests manual grading would cost between £25 676 and £267 115 per additional quality adjusted life year gained. Conclusions Algorithm (b) is more cost-effective than the algorithm based on quality assessment and MA/DH detection. With respect to the value of introducing automated detection systems into screening programmes, automated grading operates within the recommended national standards in Scotland and is likely to be considered a cost-effective alternative to manual disease/no disease grading.

Aims: National screening programmes for diabetic retinopathy using digital photography and multi-level manual grading systems are currently being implemented in the UK. Here, we assess the cost-effectiveness of replacing first level manual grading in the National Screening Programme in Scotland with an automated system developed to assess image quality and detect the presence of any retinopathy. Methods: A decision tree model was developed and populated using sensitivity/specificity and cost data based on a study of 6722 patients in the Grampian region. Costs to the NHS, and the number of appropriate screening outcomes and true referable cases detected in 1 year were assessed. Results: For the diabetic population of Scotland (approximately 160 000), with prevalence of referable retinopathy at 4% (6400 true cases), the automated strategy would be expected to identify 5560 cases (86.9%) and the manual strategy 5610 cases (87.7%). However, the automated system led to savings in grading and quality assurance costs to the NHS of £201 600 per year. The additional cost per additional referable case detected (manual vs automated) totalled £4088 and the additional cost per additional appropriate screening outcome (manual vs automated) was £1990. Conclusions: Given that automated grading is less costly and of similar effectiveness, it is likely to be considered a cost-effective alternative to manual grading.

OBJECTIVE—To evaluate the cost-effectiveness of interferon beta-1b (IFβ-1b) for relapsing-remitting multiple sclerosis (RRMS). METHODS—Construction of a cost-effectiveness model using published data on IFβ-1b effectiveness and the natural history of RRMS, and new data on costs and quality of life (QoL) from a sample of 102patients with RRMS and resident in northern England. RESULTS—Poorer QoL was found for patients with multiple sclerosis compared with the general population; those who had had a relapse; those with worse states identified by a clinical measure (expanded disability status scale (EDSS)). Relapses have effects over several months. Health state valuations were higher than in the general population. Costs were higher in relapse than remission and for worse EDSS states. IFβ-1b costs were larger than cost savings. The best cost-effectiveness estimate was £28 700 per relapse avoided, which is £809 900 per QALY gained; or £328 300 per QALY gained allowing for effects of progression over 5 years. Estimates were robust to changes in assumptions. CONCLUSIONS—The impact of multiple sclerosis on QoL is substantial. Future trials should base outcomes measurement on QoL and be better linked to natural history and cost data. IFβ-1b produces important occasional short term QoL gains, but small gains in QALYs overall and large additional costs.

Background Chronic pain is a particular problem for older adults: age-related biopsychosocial changes can make it more difficult to deal with the effects of chronic pain, and widely held views that living with pain is a natural consequence of aging can add to the problem. For many older people their role as a grandparent is a significant part of their life and this can be disrupted by chronic pain. As part of a large study on self management by older people with chronic pain (EOPIC) we developed a comic book to address an issue that older people highlighted as important to them: a lack of understanding by their grandchildren and other family members of how pain affects the older person. The comic book, “What9s Up With Moira9s Grandad? Medikidz Explain Chronic Pain”, presents key information, including that gathered within the EOPIC study from interviews with older people about their experience of living with pain. The book was developed in partnership with Medikidz, in their specialist format of comic books of health information for children and younger people. Objectives To explore older people9s views on the value of the comic book. Methods This is a qualitative study using semistructured interviews. Participants were older people over 65 years with self-reported chronic pain, living in the community, who were grandparents. Purposive sampling was used to recruit men and women from a range of ages. Participants were given a copy of the comic book to use at their discretion. They then took part in a face to face interview during which they discussed their thoughts on the value of the book in the context of their role as a grandparent. The interviews were audio recorded and transcribed. The transcripts were analysed thematically. Results 13 people have been interviewed (6 women, 7 men; age range 63-87; range of duration of living with pain 3-30 years). Discussions described various degrees of disruptive effects of chronic pain on grandparenting, and understanding by young people and other family members of older people with chronic pain. Most participants were very positive about the potential of the book to facilitate young people9s understanding about chronic pain and its effects in older people, highlighting issues including the attractiveness of the format, the authenticity of the story, and the comprehensive scope of the information. Conclusions The comic book is a potentially useful resource to facilitate the understanding of younger people, and the wider family, about how chronic pain affects older adults. Acknowledgements The study was supported by a grant from the Joint UK Research Council Lifelong Health and Wellbeing initiative. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3029

Background Cognitive behaviour therapy (CBT) and exercise have been shown to result in improved outcomes for patients with fibromyalgia or chronic widespread pain (CWP), although whether they can deliver long-term benefit is unknown. Objectives To determine the long-term health effects of telephone-delivered CBT (tCBT), exercise, and combined treatments compared with treatment as usual (TAU) among patients with CWP. Methods The MUSICIAN Trial was a 2x2 factorial randomized controlled trial. Patients with CWP were identified from a screening survey sent to patients over 25 years old registered at 8 UK general practices. Eligible individuals were patients meeting the ACR definition of CWP, reporting disability, who had consulted their family physician in the last year and with no cause for their pain identified requiring alternative treatment. They were randomly assigned to one of four study arms: tCBT, exercise, combined tCBT and exercise, or TAU. Participants receiving tCBT had 8 telephone sessions provided weekly with a therapist involving techniques to manage pain, and had follow-up calls at 3 and 6 months. Patients in the exercise group followed a 6 month exercise program to improve cardiovascular fitness individually designed for them by a fitness instructor with whom they had monthly reviews. Patients assigned to combined treatment received both interventions concurrently, while the TAU group received usual care from their family physician. Participants were followed up at 30 months post-randomisation with a postal questionnaire or by telephone (in case of non-response). The primary outcome (change in health since entering study) was considered positive if a subject scored at least 6 (“I feel much better“) on a 7 point scale from 1 (“I feel very much worse “) to 7 (“I feel very much better “). Analysis was by logistic regression which adjusted for age, gender, centre and baseline predictors of outcome, to obtain measures of improvement in the active treatment groups compared to the TAU group. Results are reported as odds ratios (OR) and 95% confidence intervals (CI). Results A total of 442 persons entered the study and 361 persons provided responses at 30 months follow-up. Median age of participants was 57 years (interquartile range, 47-65). Of 94 respondents at 30 months follow-up in the TAU group, 12 (12.8%) reported a positive outcome, compared to 29 out of 82 in the tCBT group (35.4%), 27 out of 92 in the exercise group (29.4%) and, 29 out of 93 in the combined group (31.2%). Odds of improvement compared to TAU, after adjustment were: tCBT, OR 4.0 (95% CI, 1.8-8.7); exercise, 2.9 (1.4-6.3); combined, 3.5 (1.6-7.5). Odds of improvement were not significantly different across the three active treatment groups and specifically there was no added benefit of receiving both interventions. Conclusions A six month programme of tCBT and/or exercise for CWP is associated with long-term improvements in patient global assessment of health. Disclosure of Interest None Declared