MedicalResearch.com Interview with:
Jagpreet Chhatwal PhD
Assistant Professor, Harvard Medical School
Senior Scientist, Institute for Technology Assessment
Massachusetts General Hospital
Chin Hur, MD
Associate Professor of Medicine
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: Nonalcoholic steatohepatitis (NASH), a severe form of nonalcoholic fatty liver disease, is one of the leading causes of liver transplantation. Because of increasing prevalence of obesity in the United States, NASH-related cirrhosis cases are expected to increase in the near future. Unfortunately, there are few pharmacological treatments for NASH, and none with proven long-term benefit. Weight loss can be effective in managing NASH but not many patients can lose the sufficient weight necessary to impact NASH and/or maintain long-term weight loss. In contrast, bariatric surgery can provide long-term weight loss and thus potentially reverse liver damage in cirrhosis. However, bariatric surgery is associated with mortality and morbidity associated with the procedure.
MedicalResearch.com: What are the main findings?
Response: In this study, we developed a mathematical model to simulate a virtual trial to assess if the benefits of bariatric surgery outweigh the harms for patients with NASH cirrhosis. Our modeling analysis compared the long-term effectiveness and cost-effectiveness of bariatric surgery versus lifestyle interventions in patients with NASH cirrhosis. We found that laparoscopic sleeve gastrectomy was cost-effective in overweight as well as severely obese patients – surgery increased quality-adjusted life years (QALYs) by 0.26–1.18 and yielded an incremental cost-effectiveness of $6,600–66,000 per additional QALY.
MedicalResearch.com: What should readers take away from your report?
Response: Bariatric surgery could be a cost-effective intervention in patients with NASH cirrhosis who are overweight or obese.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our analysis underscores the importance and need for future clinical studies that evaluate the benefits and risk of bariatric surgery in this population of high unmet need.
Dr. Chhatwal has received research grants and consulting fee from Gilead and Merck outside this work.
Dr. Hur has received consulting fees from Precision Health Economics, Gilead, Novo Nordisk outside this work.
Klebanoff MJ, Corey KE, Samur S, et al. Cost-effectiveness Analysis of Bariatric Surgery for Patients With Nonalcoholic Steatohepatitis Cirrhosis. JAMA Netw Open. 2019;2(2):e190047. doi:10.1001/jamanetworkopen.2019.0047
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