Taiwan RCT Model Shows H. pylori Stool Antigen Co-Testing Delivers Fivefold Economic Return on Gastric Cancer Prevention

The 10-year pragmatic RCT demonstrated that integrated HPSA-FIT screening simultaneously targets two high-burden cancers. The subsequent cost-effectiveness analysis used a decision-tree Markov model calibrated to Taiwan incidence and cost data, then tested sensitivity under U.S. and European pricing. Results remained cost-saving even when antibiotic resistance and reinfection rates were elevated, primarily because averted gastrectomies and chemotherapy outweighed upfront test and eradication expenses.

Gastric cancer remains the fifth-leading cause of cancer death globally, with incidence concentrated in East Asia and parts of Latin America. The Taiwan findings align with earlier observational cohorts from Korea and Japan showing 30-50% mortality reductions after population H. pylori treatment, yet add the missing economic dimension required for policy adoption in middle-income settings where per-capita health budgets constrain new programs.

An accompanying editorial correctly notes generalizability hinges on local incidence thresholds and resistance patterns. Next steps include cluster-randomized implementation trials in Vietnam and Chile measuring both 5-year mortality impact and real-world adherence, plus WHO prequalification review of low-cost HPSA kits to accelerate procurement.