Cost-Effectiveness of Fecal Immunochemical Testing Alone vs Co-Testing With Helicobacter pylori Stool Antigen.
Journal
JAMA
Journal Volume
336
Journal Issue
1
Start Page
35
End Page
46
ISSN
1538-3598
Date Issued
2026-07-07
Author(s)
Lee, Yi-Chia
Liu, Jui-Hsuan
Mülder, Duco T
Yang, Jeong Yun
Chiang, Tsung-Hsien
Hsu, Wen-Feng
Chiu, Han-Mo
Su, Wei-Wen
Chou, Kun-Ching
Chen, Sam Li-Sheng
Fann, Jean Ching-Yuan
Chiu, Sherry Yueh-Hsia
Chuang, Shu-Lin
Chen, Yi-Ru
Chu, Teresa Cheng-Chieh
Chen, Shih-Tien
Hu, Tsung-Hui
Fang, Yi-Jen
Liou, Jyh-Ming
Wu, Ming-Shiang
Yeh, Yen-Po
Hur, Chin
Yen, Amy Ming-Fang
Chen, Tony Hsiu-Hsi
Abstract
Importance: Helicobacter pylori infection is the leading cause of gastric cancer, yet the economic value of population-based screening and eradication remains uncertain. Objective: To project the lifetime health benefits and costs of invitation to 1-time H pylori stool antigen testing added to biennial fecal immunochemical test (FIT) screening compared with FIT alone. Design, Setting, and Participants: Lifetime cost-effectiveness analysis conducted using a Markov decision-analytic model to simulate a cohort informed by a pragmatic randomized clinical trial in Changhua County, Taiwan. The model adopted a 30-year time horizon and projected long-term outcomes, including gastric and colorectal cancer mortality, quality-adjusted life-years (QALYs; incorporating both life expectancy and health-related quality of life), and health care expenditures. Costs were evaluated from a societal perspective. One-way and probabilistic sensitivity analyses were performed. Future costs and QALYs were discounted at an annual rate of 3%. Exposures: Helicobacter pylori stool antigen testing plus FIT or FIT alone. Main Outcomes and Measures: Incremental cost-effectiveness ratio of invitation for H pylori stool antigen testing plus FIT vs FIT alone, measured as the additional cost required to gain 1 QALY per person. Secondary outcomes included net monetary benefit and benefit-cost ratio. Results: Compared with FIT alone, invitation to co-testing was more effective and less expensive (dominant), with a base-case cost-saving incremental cost-effectiveness ratio of $2094 per QALY gained (95% CI, $12359 saved to $7291 additional cost). This resulted in a positive net monetary benefit, indicating that health benefits exceeded costs, and a benefit-cost ratio of 5.08, indicating an approximately 5-fold return on investment in the Taiwanese population. At a willingness-to-pay threshold of 1 × the Taiwan gross domestic product per QALY ($33365), invitation to co-testing remained cost-saving in 65.7% of simulations. From a US cost perspective, invitation to co-testing was not cost-saving but remained cost-effective at the trial base-case H pylori prevalence. Sensitivity analyses identified H pylori prevalence as the dominant driver; co-testing exceeded a $100000-per-QALY threshold when prevalence fell below 21.9%. Conclusions and Relevance: In a pragmatic real-world setting with incomplete adherence, invitation to combined H pylori stool antigen testing and FIT was more cost-effective than FIT alone, improving lifetime outcomes and yielding cost savings in Taiwan while remaining cost-effective in higher-cost settings under moderate H pylori prevalence.
Publisher
American Medical Association
Type
journal article