Study: Bariatric surgery offers cost, survival benefits for cirrhosis patients

Editor's Note

Bariatric surgery improves survival and appears cost-effective over a decade for patients with obesity and compensated cirrhosis, according to an April 18 report in Healio. The findings, based on an analysis published in JAMA Surgery, suggest that bariatric surgery could fill a crucial gap in care for this population, where few other interventions have reportedly demonstrated both clinical and economic benefit.

As detailed in the article, researchers led by Dr. David E. Kaplan at the University of Pennsylvania evaluated outcomes and costs among veterans with obesity, including a subgroup with cirrhosis, comparing those who underwent bariatric surgery to matched controls who participated in lifestyle modification programs. The study included nearly 7,000 surgical patients and over 34,000 controls, with a focused analysis of 426 patients with both obesity and cirrhosis.

Although health care costs for surgical patients were higher in the short term and over 10 years—primarily due to preparation, additional procedures, and post-surgical care—the long-term benefits proved significant, Healio reports. For the subgroup with cirrhosis, both sleeve gastrectomy and Roux-en-Y gastric bypass were cost-effective by standard thresholds, with incremental cost-effectiveness ratios (ICERs) well below $100,000 per quality-adjusted life year. In fact, bariatric surgery was found to be cost-saving for these patients, with an ICER of –$13,395 over 10 years.

The outlet reports that survival times were also longer for surgical patients compared to those who received only lifestyle interventions. Among all patients, mean survival was 9.67 years for the surgery group versus 9.46 years for controls; among those with cirrhosis, mean survival was 9.09 years for surgical patients and 8.23 years for controls, though this difference did not reach statistical significance.

Dr. Kaplan emphasized that bariatric surgery should be strongly considered for patients with metabolic dysfunction-associated steatohepatitis (MASH) and compensated cirrhosis, as no other FDA-approved therapies have demonstrated similar benefit. The article notes that the true cost-effectiveness of surgery may be underestimated, since long-term quality-of-life improvements were not fully captured in the analysis.