Study: Bariatric surgery beats lifestyle changes for patients with cirrhosis, obesity

Editor's Note

New research shows bariatric surgery may offer better outcomes and lower overall spending than lifestyle changes for patients with cirrhosis, especially mild cases, Medscape reported April 9.

The article focuses on a study published in Jama Surgery detailing both the survival benefits and long-term cost-effectiveness for patients with obesity and compensated cirrhosis.  Researchers conducted a retrospective analysis using U.S. Veterans Health Administration data from 2008 to 2020. The study compared outcomes for 6,207 patients who underwent bariatric surgery (either sleeve gastrectomy or Roux-en-Y gastric bypass) with 31,055 patients enrolled in the MOVE! lifestyle modification program. All participants had obesity, and a subset had compensated cirrhosis. The median age of the cirrhosis subgroup was 62, with a median BMI of 41.0; all were classified as Child-Turcotte-Pugh class A.

According to the article, patients with cirrhosis who underwent bariatric surgery had a median survival of 9.09 years compared with 8.23 years in the control group—a nearly 0.9-year gain, though not statistically significant due to the small sample size. Overall, surgery patients lived on average 0.2 years longer than those receiving lifestyle-only care. These modest survival gains translated into significant cost-effectiveness when adjusted for quality of life.

The outlet reports that the incremental cost-effectiveness ratio (ICER) for patients with cirrhosis was $18,679 for sleeve gastrectomy and $44,704 for Roux-en-Y—well below the commonly accepted threshold of $100,000 to $200,000 per quality-adjusted life year (QALY) that many payers are willing to cover. For the broader cohort, ICERs were higher but still considered within acceptable ranges. The authors note that complications and long-term costs associated with cirrhosis likely contribute to the stronger cost-effectiveness seen in that subgroup.

The article also highlights commentary from outside experts, who caution that more research—including randomized trials—is needed before broader policy recommendations can be made. Still, the current evidence supports expanding access to bariatric surgery for carefully selected patients with cirrhosis. Given the rising prevalence of obesity-related liver disease and the high cost of cirrhosis-related care, the authors argue that surgery may be a worthwhile investment in both survival and system-wide healthcare savings.