ECONOMIC ANALYSES OF GENDER-AFFIRMING CARE: A LITERATURE REVIEW
Author(s)
Karen E. Sandman, PhD1, Marie Andrawes, PhD2;
1Thermo Fisher Scientific, North American Head, Value Communications, Arlington, MA, USA, 2Thermo Fisher Scientific, Newton, MA, USA
1Thermo Fisher Scientific, North American Head, Value Communications, Arlington, MA, USA, 2Thermo Fisher Scientific, Newton, MA, USA
OBJECTIVES: A 2022 US cost effectiveness analysis (CEA) (Forsythe et al) found that sexual orientation/gender identify change efforts (“conversion therapy”) cause annual harms of >$9 billion, while affirmative care yields cost savings and quality-adjusted life year (QALY) gains. This literature review further explored the economic value of gender-affirming care.
METHODS: We conducted a PubMed search (keywords: gender-affirming care, transgender care, economic), followed by citation mining/pearl-growing. Included studies reported economic outcomes of gender-affirming care for transgender individuals.
RESULTS: We included 13 studies: 4 systematic reviews and individual studies based in the US (5), Germany (2), and Canada (2), including 4 cost of care analyses, 3 CEAs, and 2 cost-utility analyses (CUAs). Three US cost of care studies reported: annual cost of providing gen[1]der-affirming care of $1,776/person ($0.06 per member per month [PMPM]); variability in cost of care by geography and type of surgery (genital: $21,487 to $26,712, chest: $13,238 to $21,309); geographic differences, with lower costs in the Northeast, suggesting possible variations in care. A German study noted no significant difference in overall healthcare costs for care-seeking transgender individuals and the general population. Both US CEAs found gender-affirming care to be cost effective: one reported an ICER of $9,314/QALY and a budget impact of $0.016 PMPM (private insurance perspective), for medically necessary procedures vs no procedures, while the other found that the ICER for gender-affirming mastectomy vs no surgery decreased from $24,979/QALY in year 2 to −$85/QALY in year 7. A German CEA concluded that a gender-affirming telehealth program was not cost-effective vs a waiting list. Two Canadian CUAs of top surgery reported that surgery was dominant versus no surgery; the 10-year ICER was −$81,183.56/QALY.
CONCLUSIONS: Gender-affirming care has modest costs and has been shown to be cost-effective from US and Canadian perspectives, due in part to offsetting severe psychiatric consequences of forgoing care.
METHODS: We conducted a PubMed search (keywords: gender-affirming care, transgender care, economic), followed by citation mining/pearl-growing. Included studies reported economic outcomes of gender-affirming care for transgender individuals.
RESULTS: We included 13 studies: 4 systematic reviews and individual studies based in the US (5), Germany (2), and Canada (2), including 4 cost of care analyses, 3 CEAs, and 2 cost-utility analyses (CUAs). Three US cost of care studies reported: annual cost of providing gen[1]der-affirming care of $1,776/person ($0.06 per member per month [PMPM]); variability in cost of care by geography and type of surgery (genital: $21,487 to $26,712, chest: $13,238 to $21,309); geographic differences, with lower costs in the Northeast, suggesting possible variations in care. A German study noted no significant difference in overall healthcare costs for care-seeking transgender individuals and the general population. Both US CEAs found gender-affirming care to be cost effective: one reported an ICER of $9,314/QALY and a budget impact of $0.016 PMPM (private insurance perspective), for medically necessary procedures vs no procedures, while the other found that the ICER for gender-affirming mastectomy vs no surgery decreased from $24,979/QALY in year 2 to −$85/QALY in year 7. A German CEA concluded that a gender-affirming telehealth program was not cost-effective vs a waiting list. Two Canadian CUAs of top surgery reported that surgery was dominant versus no surgery; the 10-year ICER was −$81,183.56/QALY.
CONCLUSIONS: Gender-affirming care has modest costs and has been shown to be cost-effective from US and Canadian perspectives, due in part to offsetting severe psychiatric consequences of forgoing care.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE493
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Reproductive & Sexual Health, STA: Surgery