ArticleRheumatology advances in practice2026
Targeted anti-CCP testing to identify people at risk of rheumatoid arthritis in primary care: an early economic evaluation.
Article in Rheumatology advances in practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
Objectives: To undertake an early economic evaluation of anti-cyclic citrullinated peptide (anti-CCP) antibody testing scenarios in primary care, to improve identification of individuals at risk of rheumatoid arthritis (RA). Methods: A discrete event simulation (DES) model was developed to track a hypothetical cohort of 10 000 patients from primary care presentation with musculoskeletal (MSK) symptoms without synovitis through to secondary care rheumatology services. Multiple anti-CCP testing scenarios were evaluated, including testing all patients on first presentation and targeted testing using a novel anti-CCP prediction model. Patients with positive anti-CCP results were referred to rheumatology services. The base-case assumed no primary care anti-CCP testing with no immediate referrals. Cost-effectiveness was assessed according to the additional cost to the healthcare system required to immediately refer one patient with imminent inflammatory arthritis (IA) (developing RA or other IA within 1 year of presentation). Results: Anti-CCP testing in all patients with MSK symptoms leads to 52.7% of those with imminent IA being immediately referred, versus 23.8% with targeted testing. Average per-patient short-term healthcare costs were £77.44 (no testing), £127.83 (testing all) and £87.54 (targeted testing). Versus no testing, additional costs of £5038 (testing all) or £2234 (targeted testing) were incurred per additional patient with imminent IA immediately referred. Targeted testing incurred more favorable cost-per-referral results than indiscriminate testing over all analyses. Conclusion: Targeted anti-CCP testing is a potentially cost-effective strategy to identify patients at risk of RA and enable prompt referral. Investigation of long-term costs and outcomes is warranted to determine the optimal testing strategy.
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