news item | 07-03-2022 | 16:30
Liposuction as a treatment for lipedema is not reimbursable under basic insurance. This is what the National Institute of Health Care writes in its position Tumescent local anesthesia liposuction and vibratory microcannulas in lipoedema patients† Available scientific research does not show the effectiveness of the treatment, which means that liposuction cannot be included in the basic package.
A case with a high burden of disease
Lipoedema is a condition in which there is an abnormal distribution of fatty tissue throughout the body. Lipoedema 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. Treatment aims to improve the patient’s performance and quality of life.
Very low quality guides
The costs of care are reimbursed through basic insurance if scientific evidence is provided through research that the care works with patients. There is no evidence for LTA as a treatment for lipedema. This means that this sponsorship does not meet the requirement for admission to the basic package. In recent years, Zorginstituut has already made a negative decision about admission to the basic package in several disputes between providers, patients and health insurers. The new assessment includes 5 recent studies. These are the so-called observational studies, in which patients are followed up with pre- and post-measurements. Zorginstituut concludes that the evidence for the studies is “too low quality” for all outcome measures. This means that the effects of LTA on reducing pain and improving quality of life are not entirely certain. Based on the available research, it cannot be demonstrated that the intervention improves patients’ performance and thus contributes to their quality of life.
Advice for a new search
Based on the pathophysiology of the disease and the mechanism of action of the LTA, it is likely that this therapy will favorably affect the symptoms. We advise relevant professional and patient associations to conduct new research of good quality so that a conclusion can be drawn about the added value of this intervention for patients. Joeri Gilissen, President of NLNet Patients Association: “This is a bitter pill for women with limited function due to lipedema and for whom current non-surgical treatments are not providing adequate results or outcomes. Based on the demand for scientific evidence and the assessment methodology applied, we cannot disagree with Zorginstituut , but we see that it works in women with lipedema who undergo liposuction.So we certainly will not sit idly by.Together with the Lipedema Expert Group, in which many professionals and empirical experts are represented, we are looking into the possibilities of setting up new high-quality research short term. “
Other countries also struggle with evidence
Our position is in line with international positions that also indicate that the efficacy of liposuction has not been demonstrated. In the United States, the health insurance company has assessed that this treatment is still experimental. A study is underway in Germany to see if the treatment can be widely used in lipedema patients. The study is expected to be completed in the summer of 2025. In England, the treatment is currently being evaluated.
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