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Bariatric surgery for nonalcoholic steatohepatitis: A clinical and cost‐effectiveness analysis
Author(s) -
Klebanoff Matthew J.,
Corey Kathleen E.,
Chhatwal Jagpreet,
Kaplan Lee M.,
Chung Raymond T.,
Hur Chin
Publication year - 2017
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.28958
Subject(s) - medicine , nonalcoholic steatohepatitis , overweight , surgery , obesity , weight loss , population , gastric bypass surgery , quality adjusted life year , cost effectiveness , nonalcoholic fatty liver disease , gastric bypass , fatty liver , disease , environmental health , risk analysis (engineering)
Nonalcoholic steatohepatitis (NASH) affects 2%‐3% of the US population and is expected to become the leading indication for liver transplantation in the next decade. Bariatric surgery may be an effective but expensive treatment for NASH. Using a state‐transition model, our analysis assessed the effectiveness and cost‐effectiveness of surgery to manage NASH. We simulated the benefits and harms of laparoscopic Roux‐en‐Y gastric bypass surgery in patients defined by weight class (overweight, mild obesity, moderate obesity, and severe obesity) and fibrosis stage (F0‐F3). Comparators included intensive lifestyle intervention (ILI) and no treatment. Quality‐adjusted life years (QALYs), costs, and incremental cost‐effectiveness ratios were calculated. Our results showed that surgery and ILI in obese patients (with F0‐F3) increased QALYs by 0.678‐2.152 and 0.452‐0.618, respectively, compared with no treatment. Incremental cost‐effectiveness ratios for surgery in all F0‐F3 patients with mild, moderate, or severe obesity were $48,836/QALY, $24,949/QALY, and $19,222/QALY, respectively. In overweight patients (with F0‐F3), surgery increased QALYs by 0.050‐0.824 and ILI increased QALYs by 0.031‐0.164. In overweight patients, it was cost‐effective to reserve treatment only for F3 patients; the incremental cost‐effectiveness ratios for providing surgery or ILI only to F3 patients were $30,484/QALY and $25,367/QALY, respectively. Conclusions : Surgery was both effective and cost‐effective for obese patients with NASH, regardless of fibrosis stage; in overweight patients, surgery increased QALYs for all patients regardless of fibrosis stage, but was cost‐effective only for patients with F3 fibrosis; our results highlight the promise of bariatric surgery for treating NASH and underscore the need for clinical trials in this area. (H epatology 2017;65:1156‐1164).