Study supports bariatric surgery in patients with obesity and cirrhosis
An economic evaluation of Veterans Health Administration data found that bariatric surgery was cost-effective among patients with cirrhosis at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year.
Bariatric surgery is associated with improved overall survival among patients with obesity and compensated cirrhosis and is cost-effective in this population, a retrospective cohort study found.
Researchers assessed data from U.S. veterans with a body mass index (BMI) higher than 35 kg/m2 or with a BMI higher than 30 kg/m2 and more than one major metabolic comorbidity. Patients were referred to a structured lifestyle modification program (MOVE!), and a subset proceeded to bariatric surgery, including sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB), between 2008 and 2020. Investigators used risk-set matching to match bariatric surgery cases 1 to 5 with nonsurgical controls. Primary outcomes included incremental cost-effectiveness ratios (ICERs) of sleeve gastrectomy or RYGB versus MOVE! over 10 years. Secondary outcomes included overall survival, quality-adjusted survival, and weight loss achieved. A total of 4,301 sleeve gastrectomy, 1,906 RYGB, and 31,055 MOVE! participants, among whom 64, 8, and 354, respectively, had cirrhosis, were included in the analysis. Median patient age was 52 years, and 68.7% of the cohort was male. Findings were published by JAMA Surgery on April 2.
Compared with the lifestyle intervention, bariatric surgery was associated with longer observed survival (9.67 years vs. 9.46 years) in the overall cohort. The observed increase in survival was more pronounced but did not meet statistical significance in patients with cirrhosis: 9.09 years (95% CI, 8.53 to 9.57) for surgery cases versus 8.23 years (95% CI, 7.91 to 8.55) for nonsurgical controls. In addition, the ICER for sleeve gastrectomy and RYGB was $132,207 and $159,027, respectively, in the overall cohort and $18,679 and $44,704, respectively, in the cirrhosis cohort. At a willingness-to-pay threshold of $100,000 per quality-adjusted life-year, bariatric surgery was cost-effective among patients with cirrhosis.
The authors noted that “the ICER for bariatric surgery remained favorable for costs across various time frames, including the first, first through second, and first through tenth years” among patients with cirrhosis.
Limitations include that the majority of included patients were men, limiting generalizability to female patients, and that reliance on administrative data may have prevented inclusion of all relevant covariates.
“Despite higher costs observed over 10 years, the benefits in terms of survival and quality of life may justify the investment, particularly when considering the long-term health improvements and potential reductions in obesity-related comorbidities,” the researchers concluded.