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.

BACKGROUND AND AIMS: 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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.