Patients with cirrhosis and obesity who undergo bariatric surgery see the advantages of 10 years survival that make surgery profitable compared to people who only receive a lifestyle intervention, has shown new research.
The study indicates that “for patients with obesity and steatohepatitis remunerated by metabolic dysfunction (Mash), bariatric surgery reaches the weight loss necessary to reduce steathepatitis safely,” said first author David E. Kaplan, MD, of the University of Pennsylvania Perelman School of Medicine, Philadelphia, of the University of Pennsylvania Perelman School of Medicine, Philadelphia, of the University Medical News MEDSCAPE.
“Although there is a high initial cost (surgery), survival is improved and over 10 years, the initial costs are largely offset by reduced costs linked to the decompensation of liver disease.”
This study has been published In Jama surgery.
The prevalence of obesity puree has increased, and if the condition is getting worse to cirrhosis, the decompensation decompensation. Weight loss is the only treatment that is effective in such cases; However, efforts thanks to conventional modifications of the lifestyle are notoriously difficult.
Bariatric surgery has been shown to be much more with weight loss and to improve survival; However, it is delivered with significant costs of costs, the preheating interventions of surgery mandated by payers and other factors.
With data missing on the efficiency and profitability of surgery in patients with obesity and cirrhosis, Kaplan and his colleagues conducted retrospective study, turning to data on patients with obesity in the American database of the health administration of veterans between 2008 and 2020.
Among the patients who have undergone bariatric surgery, 4301 underwent a sleeve gastrectomy and 1906 underwent red-red gastric surgery (RYGB).
Patients in bariatric surgery were compared to a control group of 31,055 patients, also obese, who received only a program to modify structured lifestyle (move!), And not surgery.
In the three groups, a certain number of patients with cirrhosis were 64, 8 and 354 respectively. Their median age was 52 years, approximately three -quarters (68.7%) were men and their median body mass index was 41.0.
About half of the patients had type 2 diabetes at the start and more than 70% had hyperlipidemia. Patients with cirrhosis had a 62-year-old median age, and all had light cirrhosis, 100% being a class of Pughotte-Pugh A.
During the 10 -year study, those who underwent bariatric surgery had an average survival of 9.67 years, compared to 9.46 years for witness. For people with cirrhosis, median survival by bariatric surgery was 9.09 years vs 8.23 years with cirrhosis, but none has reached statistical service.
“Average survival has increased by 0.2 years, with an even greater advantage in the subset of patients with cirrhosis, 0.9 years,” the authors reported.
The study has shown that the additional profitability ratio (ICER), reflecting the cost to increase each year of living with bariatric surgery after adjustment for the quality of life, was $ 1,12207 for sleeve gastrectomy and $ 159027 for RYGB in the overall cohort, while among those with cirrhosis, Icer 44,704 $ for RYGB.
In general, “payers are willing to pay $ 100-200,000 per year of quality of life acquired by intervention,” noted Kaplan, suggesting the profitability of surgery.
“The cost of surgery has led to barriers to payers who limit access,” he added. “This study shows that bariatric surgery is profitable and perhaps economic in this population of patients.”
“Bariatric surgery has proven to be profitable by a desire to pay $ 100,000 per year of life adjusted according to quality (Qaly) in patients with cirrhosis.”
The current results “support the extended use of bariatric surgery in appropriate patients, including those with cirrhosis, to improve results and reduce the costs of long -term health care,” the authors reported.
“Rygb gastrectomy and sleeves showed favorable results concerning body weight loss and survival compared to the program!
Cirrhosis associated with “significantly” higher health costs
Commenting on the study, Fasiha Kanwal, MD, of the section of gastroenterology and hepatology, Department of Medicine, Baylor College of Medicine, Houston, noted that “the data of this study are encouraging. However, they are limited with the relatively low number of patients with cirrhosis.
“Despite these limits, this is an important article that will generate more research to answer this important question,” she said Medical News MEDSCAPE.
In Research published last yearKanwal and his team reported “significantly higher health costs” in patients with cirrhosis than in cirrhosis witnesses, with cirrhosis counts representing most of the excess cost.
Although current guidelines recommends considering surgery in carefully selected patients with cirrhosis, “this (new) study provides additional support for guidelines,” Kanwal said.
However, “we will need more evidence of several studies and ideally randomized controlled trials, before stronger recommendations can be made.”
In the end, the “advantages of survival and quality of life of the study are remarkable,” added Kanwal. “Despite higher surgery costs, this can be worth investment.”
Kaplan reported subsidies from Astrazeneca, Gilead Sciences, Glycotet, exact sciences and health costs and Bausch de Roche-Genentech outside the work submitted. Kanwal had no disclosure to report.