A NEW economic evaluation has shown that bariatric surgery is not only effective in improving survival among patients with obesity and compensated cirrhosis but is also highly cost-effective. The study, which analysed data from over 37,000 US veterans between 2008 and 2023, compared two types of bariatric surgery, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), against a structured lifestyle modification programme (MOVE!).
The cohort included individuals with a body mass index over 35, or over 30 with at least one major metabolic condition. Among the participants, a small but significant subgroup had compensated cirrhosis. Patients undergoing SG or RYGB experienced longer survival compared to those receiving lifestyle interventions alone. Specifically, survival in the cirrhosis group increased from 8.23 years with MOVE! to 9.09 years with SG or RYGB.
Crucially, the study found that bariatric surgery was cost-effective based on the incremental cost-effectiveness ratio (ICER). In the cirrhosis cohort, the ICER was 18,679USD for SG and 44,704USD for RYGB – well below the commonly accepted US threshold of 100,000USD per quality-adjusted life-year. These figures suggest that both procedures offer excellent value for money. In fact, over a 10-year horizon, the interventions may even result in cost savings when factoring in reduced healthcare utilisation linked to improved health outcomes.
While barriers to bariatric surgery still exist, particularly in patients with liver disease due to concerns about surgical risks, this study strongly supports its expanded use in select individuals with compensated cirrhosis. Improved overall survival, meaningful weight loss, and high cost-effectiveness make SG and RYGB compelling treatment options.
In conclusion, bariatric surgery offers a clinically and economically advantageous strategy for managing obesity in patients with compensated cirrhosis. These findings may help to reshape current treatment pathways and promote broader adoption of surgical interventions in this high-risk population.
Reference
Bansal S et al. Survival and cost-effectiveness of bariatric surgery among patients with obesity and cirrhosis. JAMA Surg. 2025;DOI:10.1001/jamasurg.2025.0490.
