In Reply We thank Dr Huynh and colleagues for their thoughtful comments on our economic evaluation of HPSA-FIT co-testing. Rather than modeling a program developed de novo, we evaluated the incremental value of integrating HPSA testing into an established colorectal cancer screening program. Accordingly, infrastructure development costs were not included in our analysis; however, this should not be interpreted as suggesting implementation requires only minimal investment. Health system readiness varies considerably across countries, but we regard such heterogeneity as support for a staged implementation strategy rather than a limitation: countries with established FIT programs can readily add HPSA testing to existing stool-based testing pathways, whereas those with less mature systems may need to strengthen registries, laboratory networks, referral pathways, and treatment capacity.
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