Health Institute: More Research Needed on Effectiveness of Liposuction in Lipedema

miscellaneous | 07-03-2022 | 4:30 p.m.

Liposuction as a treatment for lipedema is not reimbursed by basic insurance. This is what the National Institute of Health Care writes in its position Liposuction under tumescent local anesthesia and vibrating microcannulas in patients with lipoedema†Available scientific research does not show the effectiveness of the treatment, which means that liposuction cannot be included in the basic package.

picture: Dutch size / ANP

A high burden case

Lipedema is a condition in which there is an abnormal distribution of fatty tissue throughout the body. Lipedema is most common in women. The most common complaint is severe pain, hypersensitivity to touch, and rapid development of bruising. Fat deposition limits freedom of movement. Tumescent local anesthesia (LTA) Liposuction is a surgical technique in which excess fat is removed under local anesthesia. The treatment aims to improve the patient’s performance and quality of life.

Very poor quality guides

Treatment costs are reimbursed by basic insurance if scientific evidence is provided by research that the treatment works with patients. There is no evidence for ALT as a treatment for lipedema. This means that this sponsorship does not meet the basic package eligibility requirements. In recent years, the Zorginstituut has already taken a negative decision regarding admission to the basic package in several disputes between providers, patients and health insurers. The new assessment includes 5 recent studies. These are so-called observational studies, in which patients are monitored with before and after measurements. The Zorginstituut concludes that the evidence from the studies is of “too low quality” for all outcome measures. This means that the effects of ALT on reducing pain and improving quality of life are not entirely certain. Based on the available research, it cannot be shown that the intervention improves patients’ performance and thus contributes to their quality of life.

Tips for a new search

Based on the pathophysiology of the disease and the mechanism of action of LTA, it is likely that this therapy will favorably affect symptoms. We advise relevant professional and patient associations to conduct further research of good quality in order to be able to draw a conclusion on the added value of this intervention for patients. Joeri Gilissen, President of Patient Association NLNet: “It’s a bitter pill for women whose function is limited due to lipedema and for whom current non-surgical treatments do not provide adequate results or results Based on the demand for scientific evidence and the evaluation methodology applied, we cannot disagree with Zorginstituut, but we find that it works in women with lipedema who undergo liposuction, so we will only stay certainly not idly. where many professionals and empirical experts are represented, we are exploring opportunities to set up new quality research in the short term.”

Other countries are also grappling with evidence

Our position is consistent with international positions which also state that the effectiveness of liposuction has not been demonstrated. In the United States, the health insurance fund has assessed that this treatment is still experimental. A study is underway in Germany to see if the treatment can be widely used in patients with lipedema. The study is expected to be completed in the summer of 2025. In England, the treatment is currently being evaluated.

Sara H. Byrd