#5-18E. Synergizing Cancer Screening: The Economics of H. pylori and FIT Co-Testing (JAMA, 2026)

Is simultaneous screening for gastric and colorectal cancers a viable and economically sound public health strategy? This episode delves into a comprehensive study evaluating the lifetime health outcomes and cost-effectiveness of adding a one-time Helicobacter pylori stool antigen (HPSA) test to biennial fecal immunochemical testing (FIT) for colorectal cancer screening. Utilizing a Markov decision-analytic model based on a pragmatic randomized clinical trial involving 240,000 individuals in Taiwan, researchers projected the long-term clinical and economic impacts over a 30-year horizon. The study's most pivotal finding reveals that incorporating HPSA testing into existing FIT programs is a "dominant" strategy, meaning it not only improves health outcomes by significantly reducing gastric cancer mortality but also lowers overall healthcare costs. While this underscores a highly efficient approach to population-level cancer prevention, clinicians must critically weigh the uncertain long-term effects of widespread antibiotic eradication on antimicrobial resistance, as well as the limited generalizability to regions with lower H. pylori prevalence. Ultimately, this evidence empowers physicians to advocate for integrated, non-invasive screening models, offering a compelling framework for preventive counseling and the optimization of regional cancer screening resources in daily clinical practice.

Citation: Lee YC, Liu JH, Mülder DT, et al. Cost-Effectiveness of Fecal Immunochemical Testing Alone vs Co-Testing With Helicobacter pylori Stool Antigen. JAMA. 2026. DOI: 10.1001/jama.2026.6908

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.