Authors' objectives: This report aims to identify and summarise the evidence that addresses the following question: 'What is the clinical and cost effectiveness of liposuction for people with chronic lymphoedema?'

Authors' results and conclusions: The literature search identified two pieces of guidance, one randomised controlled trial (RCT) and four comparative cohort studies. Individual studies from the systematic reviews included in the two identified pieces of guidance have also been included in this review. A summary of these systematic reviews, including study characteristics is available within the evidence appraisal report. The evidence included in this review suggests that liposuction for chronic lymphoedema may be effective in reducing excess oedema volume and improving quality of life for patients with upper and lower extremity lymphoedema. Outcomes for craniofacial lymphoedema remain mixed or unavailable. Cost-effectiveness studies suggest that although treatment with liposuction in addition to standard care is expected to increase quality-adjusted life years (QALY) in people with chronic lymphoedema of the upper limb, it is unlikely to be considered a cost-effective treatment option compared to standard care alone.

Authors' recommendations: The use of liposuction for the treatment of chronic lymphoedema is promising, however current evidence does not support its routine adoption in Wales. The available evidence indicates that the use of liposuction leads to a significant medium-term reduction in limb oedema volume and an improvement in quality of life for people with upper and lower limb lymphoedema, but little evidence is available for its use in craniofacial lymphoedema. Health economic assessment estimates that liposuction in addition to standard care for the treatment of upper limb lymphoedema is unlikely to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of £26,269 per QALY gained when compared to standard care alone. There is greater uncertainty, however, around the cost-effectiveness of liposuction to treat lower limb or craniofacial lymphoedema. Health Technology Wales strongly recommends the acquisition of real-world evidence on the effectiveness, patient experience, and patient outcomes of liposuction for chronic lymphoedema, particularly in people with lower limb lymphoedema.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: Health Technology Wales strongly recommends the acquisition of real-world evidence on the effectiveness, patient experience, and patient outcomes of liposuction for chronic lymphoedema, particularly in people with lower limb lymphoedema.

Project Status: Completed

Year Published: 2024

URL for published report: https://healthtechnology.wales/reports-guidance/liposuction/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk