Cost-effectiveness Analysis of Bariatric Surgery for Patients With Nonalcoholic Steatohepatitis Cirrhosis

Klebanoff, Matthew J.; Corey, Kathleen E.; Samur, Sumeyye; Choi, Jin; Kaplan, Lee M.; Chhatwal, Jagpreet; Hur, Chin

doi:10.1001/jamanetworkopen.2019.0047

Cited by 47 publications

(35 citation statements)

References 58 publications

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“…A further two articles were identified through supplementary searches of grey literature. As such, a total of 19 articles [11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] (capturing 16 different models) were included in the review; summary details of identified studies are shown in Table 1.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…A total of 13 articles assessed health economic outcomes associated with different screening or diagnostic strategies [16,[18][19][20][21][26][27][28][29][30][31][32][33]; five assessed outcomes with different treatments, including lifestyle intervention, pioglitazone, vitamin E and obeticholic acid as well as bariatric surgery for overweight/obese patients with NASH [17,[22][23][24][25]. The remaining article examined the overall clinical and economic burden of disease and as such was a non-comparative study [11].…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…In terms of utility values for different health states, three different approaches were identified. The first approach was to use utilities in patients with other liver diseases, particularly hepatitis C [17,18,22,23,25,26,33]. The second approach was to use utility values specific to NAFLD/NASH health states using data from a study by David et al [35] that assessed QoL in patients with NAFLD/NASH using the 36-item Short Form Survey (SF-36) questionnaire and then mapping these values to the Health Utilities Index (HUI)-2 [11,33].…”

Section: Health State Utilities and Costsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic Literature Review and Critical Appraisal of Health Economic Models Used in Cost-Effectiveness Analyses in Non-Alcoholic Steatohepatitis: Potential for Improvements

Johansen

Howard²,

Bishop³

et al. 2020

PharmacoEconomics

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Background Non-alcoholic steatohepatitis (NASH) is a severe, typically progressive form of non-alcoholic fatty liver disease (NAFLD). The global prevalence of NASH is increasing, driven partly by the global increase in obesity and type 2 diabetes mellitus (T2DM), such that NASH is now a leading cause of cirrhosis. There is currently an unmet clinical need for efficacious and cost-effective treatments for NASH; no pharmacologic agents have an approved indication for NASH. Objective Our objective was to summarise and critically appraise published health economic models of NASH, to evaluate their quality and suitability for use in the assessment of novel treatments for NASH, and to identify knowledge gaps, challenges and opportunities for future modelling. Methods A systematic literature review was performed using the MEDLINE, Embase, Cochrane Library and EconLit databases to identify published health economic analyses in patients with NAFLD or NASH. Supplementary hand searches of grey literature were also performed. Articles published up to November 2019 were included in the review. Quality assessment of identified studies was also performed. Results A total of 19 articles comprising 16 unique models including either NAFLD as a whole or NASH alone were included in the review. Structurally, most models had a state-transition component; in terms of health states, two different approaches to early disease states were used, modelling either progression through fibrosis stages or NAFLD/NASH-specific health states. Conditions that frequently co-exist with NASH, such as obesity, T2DM and cardiovascular disease were not captured in models identified here. Late-stage complications such as cirrhosis, decompensated cirrhosis and hepatocellular carcinoma were consistently included, but input data (e.g. costs, utilities and transition probabilities) for late-stage complications were frequently sourced from other liver disease areas. The quality of included studies was heterogenous, and only a small proportion of studies reported internal and external validation processes. Conclusion The health economic models identified in this review are associated with limitations primarily driven by a lack of NASH-specific data. Identified models also largely overlooked the intricate association between NASH and other conditions, including obesity and T2DM, and did not capture the increased risk of cardiovascular events associated with NASH. High-quality, transparent, validated health economic models of NASH will be required to evaluate the cost effectiveness of treatments currently in development, particularly compounds that may target other non-hepatic outcomes.

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Section: Literature Search Resultsmentioning

confidence: 99%

Section: Literature Search Resultsmentioning

confidence: 99%

Section: Health State Utilities and Costsmentioning

confidence: 99%

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Systematic Literature Review and Critical Appraisal of Health Economic Models Used in Cost-Effectiveness Analyses in Non-Alcoholic Steatohepatitis: Potential for Improvements

Johansen

Howard²,

Bishop³

et al. 2020

PharmacoEconomics

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“…The demographic characteristics and clinical data are summarized in Table 1. The mean age was 57 ± 13 years, 54% were men, more than 63% achieved higher than a high school diploma, 49% were Child A, 37% were Child B, 14% were Child C, and the median MELD-Na score was 12 (interquartile range [IQR], [8][9][10][11][12][13][14][15][16][17][18]. NAFLD/nonalcoholic steatoheptitis (NASH) (30%) was the most common etiology followed by alcohol (26%) and aviremic/cured-hepatitis C virus (14%).…”

Section: Cohort Descriptionmentioning

confidence: 99%

“…The epidemiology of cirrhosis has shifted, now characterized by aging persons with nonalcoholic fatty liver disease (NAFLD), alcoholrelated disease, or treated hepatitis C. (7) Cost-effectiveness analyses depend on generalizable utilities but continue to use extremely dated values that are often more than 20 years old and derived from patients with viremic hepatitis C, few of whom had decompensated cirrhosis and few of which capture the contribution of specific cirrhosis symptoms. (8)(9)(10)(11) Updated heath-state utilities are therefore needed in order to execute meaningful cost-effectiveness studies that represent contemporary patients. Herein, we prospectively evaluated health-state utilities in a large cohort of patients with cirrhosis.…”

mentioning

confidence: 99%

Comprehensive Health‐State Utilities in Contemporary Patients With Cirrhosis

et al. 2020

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Cost-effectiveness analysis depends on generalizable health-state utilities. Unfortunately, the available utilities for cirrhosis are dated, may not reflect contemporary patients, and do not capture the impact of cirrhosis symptoms. We aimed to determine health-state utilities for cirrhosis, using both the standard gamble (SG) and visual analog scale (VAS). We prospectively enrolled 305 patients. Disease severity (Child-Pugh [Child] class, Model for End-Stage Liver Disease with sodium [MELD-Na] scores), symptom burden (sleep quality, cramps, falls, pruritus), and disability (activities of daily living) were assessed. Multivariable models were constructed to determine independent clinical associations with utility values. The mean age was 57 ± 13 years, 54% were men, 30% had nonalcoholic steatohepatitis, 26% had alcohol-related cirrhosis, 49% were Child class A, and the median MELD-Na score was 12 (interquartile range [IQR], 8-18). VAS displayed a normal distribution with a wider range than SG. The Child-specific SG-derived utilities had a median value of 0.85 (IQR, 0.68-0.98) for Child A, 0.78 (IQR, 0.58-0.93) for Child B, and 0.78 (IQR, 0.58-0.93) for Child C. VAS-derived utilities had a median value of 0.70 (IQR, 0.60-0.85) for Child A, 0.61 (IQR, 0.50-0.75) for Child B, and 0.55 (IQR, 0.40-0.70) for Child C. VAS and SG were weakly correlated (Spearman's rank correlation coefficient, 0.12; 95% confidence interval, 0.006-0.23). In multivariable models, disability, muscle cramps, and MELD-Na were significantly associated with SG utilities. More clinical covariates were significantly associated with the VAS utilities, including poor sleep, MELD-Na, disability, falls, cramps, and ascites. Conclusion: We provide health-state utilities for contemporary patients with cirrhosis as well as estimates of the independent impact of specific symptoms on each patient's reported utility. (Hepatology Communications 2020;4:852-858). Abbreviations: ADL, activities of daily living; Child, Child-Pugh; CI, confidence interval; HE, hepatic encephalopathy; HRQOL, health-related quality of life; IQR, interquartile range; MELD-Na, Model for End-Stage Liver Disease with sodium; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; rs, Spearman's rank correlation coefficient; SG, standard gamble; VAS, visual analog scale.

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Considering Bariatric Surgery in Patients With Nonalcoholic Steatohepatitis—Worth the Risk

2019

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Cost-effectiveness Analysis of Bariatric Surgery for Patients With Nonalcoholic Steatohepatitis Cirrhosis

Cited by 47 publications

References 58 publications

Systematic Literature Review and Critical Appraisal of Health Economic Models Used in Cost-Effectiveness Analyses in Non-Alcoholic Steatohepatitis: Potential for Improvements

Systematic Literature Review and Critical Appraisal of Health Economic Models Used in Cost-Effectiveness Analyses in Non-Alcoholic Steatohepatitis: Potential for Improvements

Comprehensive Health‐State Utilities in Contemporary Patients With Cirrhosis

Considering Bariatric Surgery in Patients With Nonalcoholic Steatohepatitis—Worth the Risk

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