{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:23:39Z","timestamp":1792805019696,"version":"4.5.0"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,7,7]]},"abstract":"\n Importance<\/jats:title>\n \n Helicobacter pylori<\/jats:italic>\n infection is the leading cause of gastric cancer, yet the economic value of population-based screening and eradication remains uncertain.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To project the lifetime health benefits and costs of invitation to 1-time\n H pylori<\/jats:italic>\n stool antigen testing added to biennial fecal immunochemical test (FIT) screening compared with FIT alone.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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%.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n \n Helicobacter pylori<\/jats:italic>\n stool antigen testing plus FIT or FIT alone.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Incremental cost-effectiveness ratio of invitation for\n H pylori<\/jats:italic>\n 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.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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, $12\u202f359 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 \u00d7 the Taiwan gross domestic product per QALY ($33\u202f365), 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\n H pylori<\/jats:italic>\n prevalence. Sensitivity analyses identified\n H pylori<\/jats:italic>\n prevalence as the dominant driver; co-testing exceeded a $100\u202f000-per-QALY threshold when prevalence fell below 21.9%.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n In a pragmatic real-world setting with incomplete adherence, invitation to combined\n H pylori<\/jats:italic>\n 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\n H pylori<\/jats:italic>\n prevalence.\n <\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT01741363<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.6908","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T15:30:27Z","timestamp":1780327827000},"page":"35","source":"Crossref","is-referenced-by-count":8,"title":["Cost-Effectiveness of Fecal Immunochemical Testing Alone vs Co-Testing With\n Helicobacter pylori<\/i>\n Stool Antigen"],"prefix":"10.1001","volume":"336","author":[{"given":"Yi-Chia","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan"},{"name":"Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan"},{"name":"Department of Medical Research, National Taiwan University Hospital, Taipei City, Taiwan"},{"name":"Department of Internal Medicine, National Taiwan 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