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

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.