Cost-effectiveness Analysis of Bariatric Surgery for Patients With Nonalcoholic Steatohepatitis Cirrhosis

Key Points Question Is bariatric surgery cost-effective in patients with nonalcoholic steatohepatitis and compensated cirrhosis? Findings In this simulation model study, laparoscopic sleeve gastrectomy had an incremental cost-effectiveness ratio of $66 119 per quality-adjusted life-year in overweight patients, $18 716 per quality-adjusted life-year in patients with mild obesity, $10 274 per quality-adjusted life-year in patients with moderate obesity, and $6563 per quality-adjusted life-year in patients with severe obesity. Meaning Bariatric surgery could be highly cost-effective in patients with nonalcoholic steatohepatitis and compensated cirrhosis, even in those with a lower baseline body mass index.

This supplementary material has been provided by the authors to give readers additional information about their work. Negative values indicate weight loss, whereas positive values indicate weight gain. Ranges were used in one-way sensitivity analysis. β distributions were used for all weight loss values in probabilistic sensitivity analysis.
For patients who underwent laparoscopic Roux-en-Y gastric bypass (GB) or laparoscopic sleeve gastrectomy (SG), the weight loss one year after surgery was based on a recent metaanalysis. 1 In subsequent years, maintenance of weight loss after bariatric surgery was based on data from the Swedish Obese Subjects (SOS) study. 2 Weight loss in the intensive lifestyle intervention (ILI) strategy was derived from the Look AHEAD (Action for Health in Diabetes) trial. 3 After year 8, body mass index (BMI) remained stable in the ILI strategy. In the usual care strategy, patients remained at their initial BMI throughout their lifetime.
ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; HR, hazard ratio; BMI, body mass index; Prob., probability; DC, decompensated cirrhosis; CC, compensated cirrhosis; SG, laparoscopic sleeve gastrectomy; HCC, hepatocellular carcinoma eFigure 2 shows the results of one-way sensitivity analyses performed for SG (versus usual care) in patients with moderate obesity. One-way sensitivity analysis involves adjusting the value of one model parameter at a time in order to assess the impact on study outcomes. This figure includes the ten parameters that led to the largest effect on ICER values when modified. The numbers on either side of the bars indicate the extreme parameter values that led to the resulting ICER shown in the figure. This figure is centered around the base-case ICER of $10,274/QALY. High and low parameter values can be found in Table 1 and eTable 1.
ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; HR, hazard ratio; BMI, body mass index; Prob., probability; DC, decompensated cirrhosis; SG, laparoscopic sleeve gastrectomy; CC, compensated cirrhosis; HCC, hepatocellular carcinoma eFigure 3 shows the results of one-way sensitivity analyses performed for SG (versus usual care) in patients with mild obesity. One-way sensitivity analysis involves adjusting the value of one model parameter at a time in order to assess the impact on study outcomes. This figure includes the ten parameters that led to the largest effect on ICER values when modified. The numbers on either side of the bars indicate the extreme parameter values that led to the resulting ICER shown in the figure. This figure is centered around the base-case ICER of $18,716/QALY. High and low parameter values can be found in Table 1 and eTable 1.
ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; BMI, body mass index; SG, laparoscopic sleeve gastrectomy; Prob., probability; CC, compensated cirrhosis; DC, decompensated cirrhosis; HCC, hepatocellular carcinoma eFigure 4 shows the results of one-way sensitivity analyses performed for SG (versus usual care) in patients with overweight. One-way sensitivity analysis involves adjusting the value of one model parameter at a time in order to assess the impact on study outcomes. This figure includes the ten parameters that led to the largest effect on ICER values when modified. The numbers on either side of the bars indicate the extreme parameter values that led to the resulting ICER shown in the figure. This figure is centered around the base-case ICER of $66,119/QALY. High and low parameter values can be found in Table 1 and eTable 1.