The Association of a Positive Fecal Immunochemical Test With the Risk of Gastroesophageal Cancer: An Age‐Sex‐H. Pylori Exposure Matched Cohort Study and Cost‐Effectiveness Analysis

TL;DR

A positive FIT test is linked to a higher risk of gastroesophageal cancer, and a follow-up endoscopy may be cost-effective for those who test positive.

Contribution

A matched cohort study and cost-effectiveness analysis of FIT-positive individuals for gastroesophageal cancer.

Findings

FIT-positive individuals had a 39% higher risk of GEC compared to FIT-negative individuals.

A one-time EGD for FIT-positive individuals had an ICER of USD 25,535/QALY, indicating cost-effectiveness.

H. pylori exposure and immigration from high-risk countries were also associated with increased GEC risk.

Abstract

We evaluated the association between Fecal Immunochemical Test (FIT) results and the risk of gastroesophageal cancer (GEC) in a matched cohort, as well as the cost‐effectiveness of a one‐time esophagogastroduodenoscopy (EGD) for individuals who tested FIT‐positive.

We formed a cohort of individuals aged 50–75 years who underwent FIT testing at Clalit Health in Israel from 2016 to 2019. For each person with a positive FIT result, we matched three individuals with negative results by age, gender, and
H. pylori
exposure. We used adjusted hazard ratios (adjHRs) to assess the association between a positive FIT result and the risk of GEC within 36 months. We calculated the incremental cost‐effectiveness ratio (ICER) for a one‐time EGD costing USD 350 in individuals who tested positive for FIT, and considered it cost‐effective if below USD 50,000.

The study included 150,391 individuals (47.6% female, median age 62.4 years). During follow‐up, 202 cases of GEC were recorded: 0.17% in FIT‐positive individuals (64/37,709) and 0.12% in FIT‐negative individuals (138/112,682), adjHR 1.39 (95% CI 1.03–1.87). GEC was also associated with
H. pylori
exposure (adjHR 1.43, 95% CI 1.08–1.90) and immigration from high‐risk countries. A one‐time EGD demonstrated favorable cost‐effectiveness across various scenarios, with an ICER of USD 25,535/QALY.

This matched‐cohort study suggests that individuals with a positive FIT may have an increased risk of GEC, comparable to that of established high‐risk populations. Adding a one‐time EGD to colonoscopy for FIT‐positive individuals may be a cost‐effective approach for healthcare systems that can accommodate such interventions.

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