H. pylori Screening Within Colorectal Program Aids Gastric Cancer Prevention

Health systems increasingly rely on economic evidence to guide cancer prevention strategies. For gastric cancer, selecting screening approaches that can integrate with existing programs is a key policy question. Taiwan’s national colorectal screening framework offers one potential platform for combined testing. A new study shows that screening for Helicobacter pylori within this framework can deliver substantial value.

National Taiwan University Hospital and the College of Public Health at National Taiwan University developed a globally adaptable decision-tree model to evaluate the cost-effectiveness of H. pylori screening. The approach centers on co-testing with a H. pylori stool antigen (HPSA) assay alongside fecal occult blood testing within Taiwan’s fecal immunochemical test (FIT)-based colorectal cancer screening program. The analysis translates evidence from a pragmatic randomized clinical trial into estimates useful for public health decision-making. Findings were published in JAMA on June 1, 2026.

In the new work, the team built a Markov decision-analytic model to project 30-year outcomes from implementing the integrated strategy. The model compared costs associated with screening and eradication therapy against avoided spending on gastric cancer surgery, chemotherapy and targeted therapies, and incorporated expected quality-of-life effects. The group also collaborated with European and U.S. researchers to test the framework in higher-cost health care settings.

The modeling was informed by a 10-year randomized clinical trial that added HPSA to fecal occult blood testing, enabling simultaneous prevention goals for colorectal and gastric cancers; those trial findings were published in JAMA on September 30, 2024. Using these data, the model indicated that H. pylori screening is a cost-saving strategy. For every unit of cost invested, the analysis estimated roughly a fivefold return in gastric cancer prevention benefits, and cost-effectiveness persisted even in higher-cost settings.

Although initial investments are required to launch screening and provide eradication therapy, the strategy was projected to decrease future expenditures related to advanced gastric cancer treatment and to reduce disease-associated quality-of-life losses. 

"To translate the findings of this pragmatic randomized clinical trial into public health policy, cost considerations are essential," said first author Dr. Yi-Chia Lee, professor of internal medicine in the Division of Gastroenterology and Hepatology at National Taiwan University.

"Countries with gastric cancer incidence greater than or equal to that of Taiwan could expect similar economic value from HPSA screening, assuming costs, antibiotic resistance, and reinfection rates are also similar," wrote John M. Inadomi, deputy editor of JAMA.

Related Links
National Taiwan University Hospital
College of Public Health at National Taiwan University