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), healthcare 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 U.S. 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
