{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T01:49:09Z","timestamp":1790214549940,"version":"4.1.0"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2017,2,21]],"date-time":"2017-02-21T00:00:00Z","timestamp":1487635200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1"},{"start":{"date-parts":[[2017,2,21]],"date-time":"2017-02-21T00:00:00Z","timestamp":1487635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:p>Nonalcoholic steatohepatitis (NASH) affects 2%\u20103% of the US population and is expected to become the leading indication for liver transplantation in the next decade. Bariatric surgery may be an effective but expensive treatment for NASH. Using a state\u2010transition model, our analysis assessed the effectiveness and cost\u2010effectiveness of surgery to manage NASH. We simulated the benefits and harms of laparoscopic Roux\u2010en\u2010Y gastric bypass surgery in patients defined by weight class (overweight, mild obesity, moderate obesity, and severe obesity) and fibrosis stage (F0\u2010F3). Comparators included intensive lifestyle intervention (ILI) and no treatment. Quality\u2010adjusted life years (QALYs), costs, and incremental cost\u2010effectiveness ratios were calculated. Our results showed that surgery and ILI in obese patients (with F0\u2010F3) increased QALYs by 0.678\u20102.152 and 0.452\u20100.618, respectively, compared with no treatment. Incremental cost\u2010effectiveness ratios for surgery in all F0\u2010F3 patients with mild, moderate, or severe obesity were $48,836\/QALY, $24,949\/QALY, and $19,222\/QALY, respectively. In overweight patients (with F0\u2010F3), surgery increased QALYs by 0.050\u20100.824 and ILI increased QALYs by 0.031\u20100.164. In overweight patients, it was cost\u2010effective to reserve treatment only for F3 patients; the incremental cost\u2010effectiveness ratios for providing surgery or ILI only to F3 patients were $30,484\/QALY and $25,367\/QALY, respectively. <jats:italic toggle=\"yes\">Conclusions<\/jats:italic>: Surgery was both effective and cost\u2010effective for obese patients with NASH, regardless of fibrosis stage; in overweight patients, surgery increased QALYs for all patients regardless of fibrosis stage, but was cost\u2010effective only for patients with F3 fibrosis; our results highlight the promise of bariatric surgery for treating NASH and underscore the need for clinical trials in this area. (H<jats:sc>epatology<\/jats:sc> 2017;65:1156\u20101164).<\/jats:p>","DOI":"10.1002\/hep.28958","type":"journal-article","created":{"date-parts":[[2016,11,23]],"date-time":"2016-11-23T23:47:20Z","timestamp":1479944840000},"page":"1156-1164","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":84,"title":["Bariatric surgery for nonalcoholic steatohepatitis: A clinical and cost\u2010effectiveness analysis"],"prefix":"10.1097","volume":"65","author":[{"given":"Matthew J.","family":"Klebanoff","sequence":"first","affiliation":[{"name":"Gastrointestinal Unit,Massachusetts General Hospital,Boston,MA"},{"name":"Institute for Technology Assessment,Massachusetts General Hospital,Boston,MA"},{"name":"Yale University School of Medicine,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen E.","family":"Corey","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit,Massachusetts General Hospital,Boston,MA"},{"name":"Harvard Medical School,Boston,MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagpreet","family":"Chhatwal","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit,Massachusetts General Hospital,Boston,MA"},{"name":"Institute for Technology Assessment,Massachusetts General Hospital,Boston,MA"},{"name":"Harvard Medical School,Boston,MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee M.","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit,Massachusetts General Hospital,Boston,MA"},{"name":"Harvard Medical School,Boston,MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond T.","family":"Chung","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit,Massachusetts General Hospital,Boston,MA"},{"name":"Harvard Medical School,Boston,MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin","family":"Hur","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit,Massachusetts General Hospital,Boston,MA"},{"name":"Institute for Technology Assessment,Massachusetts General Hospital,Boston,MA"},{"name":"Harvard Medical School,Boston,MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,2,21]]},"reference":[{"key":"hep28958-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1038\/35007508","article-title":"Obesity as a medical problem","volume":"404","year":"2000","journal-title":"Nature"},{"key":"hep28958-bib-0002-20241017","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1053\/jhep.2003.50193","article-title":"Nonalcoholic steatohepatitis: summary of an AASLD single topic 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