Combined H. pylori and FIT Screening Found Cost-Effective for Long-Term Cancer Prevention
Adding one-time Helicobacter pylori stool antigen testing to biennial fecal immunochemical test (FIT) screening may improve long-term health outcomes while remaining economically favorable, according to a cost-effectiveness analysis based on data from a pragmatic randomized clinical trial in Taiwan.
Because H. pylori infection is the leading cause of gastric cancer, investigators evaluated whether combining H. pylori screening with FIT could provide additional value beyond colorectal cancer screening alone. Using a Markov decision-analytic model informed by a randomized trial conducted in Changhua County, Taiwan, researchers projected outcomes over a 30-year horizon.
The analysis compared invitation to one-time H. pylori stool antigen testing plus biennial FIT with FIT alone. Outcomes included gastric and colorectal cancer mortality, quality-adjusted life-years (QALYs), health care expenditures, net monetary benefit, and benefit-cost ratio.
Compared with FIT alone, the combined screening strategy was both more effective and less costly. Investigators reported a “cost-saving incremental cost-effectiveness ratio of $2094 per QALY gained” (95% CI, $12,359 saved to $7,291 additional cost). The strategy also generated a positive net monetary benefit.
Economic returns were substantial. The benefit-cost ratio was 5.08, indicating “an approximately 5-fold return on investment in the Taiwanese population.” At a willingness-to-pay threshold equal to Taiwan’s gross domestic product per QALY ($33,365), the combined strategy remained cost-saving in 65.7% of simulations.
When modeled using US cost assumptions, co-testing was no longer cost-saving but remained cost-effective at the H. pylori prevalence observed in the trial population.
H. pylori prevalence emerged as the primary determinant of economic value. Sensitivity analyses demonstrated that the combined screening approach exceeded a $100,000-per-QALY threshold when prevalence fell below 21.9%.
The authors concluded that “invitation to combined H. pylori stool antigen testing and FIT was more cost-effective than FIT alone,” producing improved lifetime outcomes and cost savings in Taiwan.
Reference
Lee YC, Liu JH, Mülder DT, et al. Cost-effectiveness of fecal immunochemical testing alone vs co-testing with Helicobacter pylori stool antigen. JAMA. Published online June 1, 2026. doi:10.1001/jama.2026.6908
