Targeted anti-CCP testing to identify people at risk of rheumatoid arthritis in primary care: an early economic evaluation

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ID: 328962
2026
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Abstract
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 £5,038 (testing all) or £2,234 (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. Conclusions : 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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Authors Alison Smith, Bethany Shinkins, E. Hensor, Michelle Wilson, Anna Anderson, Rebecca Stack, Paul Emery, Kulveer Mankia, Heidi J. Siddle
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Journal Rheumatology Advances in Practice
Year 2026
DOI
10.1093/rap/rkag111
URL
https://doi.org/10.1093/rap/rkag111
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