title: Bariatric surgery for nonalcoholic steatohepatitis: A clinical and cost-effectiveness analysis.
abstract: 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.
  
  
  
  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. (Hepatology 2017;65:1156-1164).
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.|Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.|Yale University School of Medicine, New Haven, CT.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Klebanoff
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Corey
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.|Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Jagpreet
authors.initials: J
authors.lastname: Chhatwal
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Kaplan
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.|Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Chin
authors.initials: C
authors.lastname: Hur
mesh_terms: D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D005260:Female; D015390:Gastric Bypass / Q000191:economics* / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D009767:Obesity, Morbid / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States; D057832:Watchful Waiting; D015431:Weight Loss