{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:59:42Z","timestamp":1790816382134,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":257,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Health Education England"},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A discrete event simulation (DES) model was developed to track a hypothetical cohort of 10\u00a0000 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\u2009year of presentation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u00a377.44 (no testing), \u00a3127.83 (testing all) and \u00a387.54 (targeted testing). Versus no testing, additional costs of \u00a35038 (testing all) or \u00a32234 (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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/rap\/rkag111","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:51:04Z","timestamp":1789127464000},"source":"Crossref","is-referenced-by-count":0,"title":["Targeted anti-CCP testing to identify people at risk of rheumatoid arthritis in primary care: an early economic evaluation"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7709-1869","authenticated-orcid":false,"given":"Alison F","family":"Smith","sequence":"first","affiliation":[{"name":"Leeds Institute of Health Sciences, University of Leeds , Leeds,","place":["UK"]},{"name":"NIHR HealthTech Research Centre in Accelerated Surgical Care , Leeds,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5350-1018","authenticated-orcid":false,"given":"Bethany","family":"Shinkins","sequence":"additional","affiliation":[{"name":"Leeds Institute of Health Sciences, University of Leeds , Leeds,","place":["UK"]},{"name":"Warwick Medical School, University of Warwick , Coventry,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5245-4755","authenticated-orcid":false,"given":"Elizabeth M A","family":"Hensor","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds,","place":["UK"]},{"name":"NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital , Leeds,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7556-1599","authenticated-orcid":false,"given":"Michelle","family":"Wilson","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds,","place":["UK"]},{"name":"NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital , Leeds,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4048-6880","authenticated-orcid":false,"given":"Anna M","family":"Anderson","sequence":"additional","affiliation":[{"name":"Leeds Institute of Health Sciences, University of Leeds , Leeds,","place":["UK"]},{"name":"NIHR HealthTech Research Centre in Accelerated Surgical Care , Leeds,","place":["UK"]},{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0516-0228","authenticated-orcid":false,"given":"Rebecca","family":"Stack","sequence":"additional","affiliation":[{"name":"Three Counties Medical School, University of Worcester , Worcester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7429-8482","authenticated-orcid":false,"given":"Paul","family":"Emery","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick , Coventry,","place":["UK"]},{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7945-6582","authenticated-orcid":false,"given":"Kulveer","family":"Mankia","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds,","place":["UK"]},{"name":"NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital , Leeds,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6015-332X","authenticated-orcid":false,"given":"Heidi J","family":"Siddle","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds,","place":["UK"]},{"name":"NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital , Leeds,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"2026093020070011700_rkag111-B1","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/S0140-6736(23)01525-8","article-title":"Rheumatoid arthritis","volume":"402","author":"Di 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A cost-effectiveness analysis of the randomised, placebo-controlled TREAT EARLIER trial","volume":"84","author":"van Mulligen","year":"2025","journal-title":"Ann Rheum Dis"},{"key":"2026093020070011700_rkag111-B8","author":"National Institute for Health and Care Excellence (NICE)","year":"2018"},{"key":"2026093020070011700_rkag111-B9","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s13075-022-02717-w","article-title":"Prioritising referrals of individuals at-risk of RA: guidance based on results of a 10-year national primary care observational study","volume":"24","author":"Garcia-Montoya","year":"2022","journal-title":"Arthritis Res Ther"},{"key":"2026093020070011700_rkag111-B10","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.7326\/M23-0272","article-title":"Predicting inflammatory arthritis in at-risk persons: development of scores for risk stratification","volume":"176","author":"Duquenne","year":"2023","journal-title":"Ann Intern 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